Striatal correlates of Bayesian beliefs in self-efficacy in adolescents and their relation to mood and autonomy: a pilot study

Major depressive disorder often originates in adolescence and is associated with long-term functional impairment. Mechanistically characterizing this heterogeneous illness could provide important leads for optimizing treatment. Importantly, reward learning is known to be disrupted in depression. In this pilot fMRI study of 21 adolescents (16-20 years), we assessed how reward network disruption impacts specifically on Bayesian belief representations of self-efficacy (SE-B) and their associated uncertainty (SE-U), using a modified instrumental learning task probing activation induced by the opportunity to choose, and an optimal Hierarchical Gaussian Filter computational model. SE-U engaged caudate, nucleus accumbens (NAcc), precuneus, posterior parietal and dorsolateral prefrontal cortex (PFWE < 0.005). Sparse partial least squares analysis identified SE-U striatal activation as associating with one's sense of perceived choice and depressive symptoms, particularly anhedonia and negative feelings about oneself. As Bayesian uncertainty modulates belief flexibility and their capacity to steer future actions, this suggests that these striatal signals may be informative developmentally, longitudinally and in assessing response to treatment.

Keeping up with the kids: the value of co-production in the study of irritability in youth depression and its underlying neural circuitry

Irritability is a core symptom of adolescent depression, characterized by an increased proneness to anger or frustration. Irritability in youth is associated with future mental health problems and impaired social functioning, suggesting that it may be an early indicator of emotion regulation difficulties. Adolescence is a period during which behavior is significantly impacted by one's environment. However, existing research on the neural basis of irritability typically use experimental paradigms that overlook the social context in which irritability occurs. Here, we bring together current findings on irritability in adolescent depression and the associated neurobiology and highlight directions for future research. Specifically, we emphasize the importance of co-produced research with young people as a means to improve the construct and ecological validity of research within the field. Ensuring that our research design and methodology accurately reflect to lives of young people today lays a strong foundation upon which to better understand adolescent depression and identify tractable targets for intervention.

Effects of soothing images and soothing sounds on mood and well-being

OBJECTIVES

Mental health problems are increasing at an alarming rate, calling for the need for more cost-effective and easily accessible interventions. Visual images and sounds depicting nature have been found to have positive effects on individuals' mood and well-being; however, the combined effects of images and sounds have been scarcely investigated. This study therefore aimed to compare the mood effects of viewing nature-related soothing images versus listening to soothing sounds versus a combination of both.

METHODS

In this study, 149 participants aged 18-83 years old (M = 35.88, SD = 15.63; 72.5% female, male 26.8%, .7% transgender) were randomised into three intervention conditions: images only, sounds only or combined (images and sounds). Baseline depressive and anxiety symptoms were indexed, and four outcome variables (positive affect, negative affect, serenity affect and depressive mood states) were measured pre- and post-intervention.

RESULTS

Findings showed that all participants, regardless of group, reported a decrease in negative affect, positive affect and depressive mood as well as an increase in serenity affect (including feelings of soothe). However, there were no group differences. Exploratory analyses found that individuals with higher levels of depressive and anxiety symptoms at baseline experienced greater reduction in negative affect and depressive mood state, as well as a larger increase in serenity affect.

CONCLUSIONS

These findings therefore provide preliminary evidence that, upon further research and development, images and sounds depicting nature can potentially be developed for use as an effective tool to improve mood and well-being.

Measurement invariance of the Multidimensional Depression Assessment Scale (MDAS) across gender and ethnic groups of Asian, Caucasian, Black, and Hispanic

BACKGROUND

Major Depressive Disorder is a severe and highly disabling mental illness. Almost all self-reported questionnaires have overlooked the interpersonal symptoms of depression which are important across gender and culture. The Multidimensional Depression Assessment Scale (MDAS) developed by Cheung and Power (2012) entails comprehensive emotional, cognitive, somatic, and interpersonal subscales. It addresses the criticism that existing self-report depression scales might not cover sufficient phenomenological heterogeneity of depression. The current study aimed to evaluate the psychometric properties of the MDAS across gender and four major ethnic groups of Caucasian, Black, Asian and Hispanic, including reliability and concurrent validity against the Centre for Epidemiological Studies Depression Scale (CESD) and Patients Health Questionnaire (PHQ-9). It also aimed to establish a stable factor structure across gender and ethnic groups and test the measurement invariance to enhance its potential for clinical use.

METHODS

A community sample of 3499 participants from four ethnic groups were recruited via online crowdsourcing sites of Qualtrics and Amazon M Turk. Each individual completed a demographic questionnaire, the MDAS, CESD and PHQ-9.

RESULTS

There was good internal consistency (Cronbach's alpha >0.90) and concurrent reliability across gender and ethnic groups. Strict measurement invariance was established for MDAS over a four-factor factor structure corresponding to the four subscales.

CONCLUSIONS

The MDAS showed good psychometric properties and measurement invariance of a four-factor structure, suggesting its potential to be used in clinical settings across gender and ethnic groups.

LIMITATIONS

Participants all answered the questionnaires in English, which could hinder cultural variations in their expression of symptoms.

Experience of clinical services shapes attitudes to mental health data sharing: findings from a UK-wide survey

BACKGROUND

Routinely-collected mental health data could deliver novel insights for mental health research. However, patients' willingness to share their mental health data remains largely unknown. We investigated factors influencing likelihood of sharing these data for research purposes amongst people with and without experience of mental illness.

METHODS

We collected responses from a diverse sample of UK National Health Service (NHS) users (n = 2187) of which about half (n = 1087) had lifetime experience of mental illness. Ordinal logistic regression was used to examine the influence of demographic factors, clinical service experience, and primary mental illness on willingness to share mental health data, contrasted against physical health data.

RESULTS

There was a high level of willingness to share mental (89.7%) and physical (92.8%) health data for research purposes. Higher levels of satisfaction with the NHS were associated with greater willingness to share mental health data. Furthermore, people with personal experience of mental illness were more willing than those without to share mental health data, once the variable of NHS satisfaction had been controlled for. Of the mental illnesses recorded, people with depression, obsessive-compulsive disorder (OCD), personality disorder or bipolar disorder were significantly more likely to share their mental health data than people without mental illness.

CONCLUSIONS

These findings suggest that positive experiences of health services and personal experience of mental illness are associated with greater willingness to share mental health data. NHS satisfaction is a potentially modifiable factor that could foster public support for increased use of NHS mental health data in research.

Relationship between Early Maladaptive Schemas and Anxiety in Adolescence and Young Adulthood: A systematic review and meta-analysis

BACKGROUND

Early maladaptive schemas (EMS) are self-perpetuating dysfunctional cognitive structures that have been linked with youth psychological health and play a significant role in developing and maintaining psychological distress, including anxiety symptoms.

METHOD

The present meta-analysis synthesises the existing literature to evaluate the strength of association between EMS and anxiety symptoms among adolescents and young adults (aged 10-29 years). The systematic literature search was carried out in October 2019 using six different databases.

RESULTS

Our systematic search has identified 15 studies, comprising of 9515 participants (Mean age = 18.95, SD = 5.30). All the studies assessed were either cross-sectional or longitudinally designed. The random effect estimate for overall EMS with anxiety was r = 0.59 (95% Cl = 0.50 to 0.68, Z = 9.69, p < 0.0001), indicating a strong association between EMS and anxiety. When different schema domains were investigated separately, anxiety was shown to have significantly stronger associations with the schema domains of disconnection/rejection (r = 0.50), impaired autonomy/performance (r = 0.47) and other-directedness (r = 0.49). Further, females were found to have higher schemas of hypervigilance and other-directedness and associated anxiety symptoms compared to males.

LIMITATIONS

Meta-analytical results were limited to articles published in peer-reviewed journals in English language, inducing an upward publication bias and limiting the generalizability of the findings.

CONCLUSIONS

The findings highlight schemas related to disconnection/rejection, impaired autonomy/performance and other-directedness as particularly salient precursors of anxiety symptoms, providing evidence for clinicians to target these particular schemas during prevention, intervention, and management of anxiety disorder.

'Faking it': Exploring adolescent perceptions of depression (in)authenticity and 'attention seeking'

OBJECTIVES

Attitudes towards peers who are not perceived to be legitimately depressed, or whose depression 'authenticity' is questioned, represent a current gap in adolescent depression stigma research. This research study, therefore, investigated how perceptions of depression inauthenticity are framed in adolescent Reddit communities.

METHODS

This observational study used an internet-mediated, qualitative methodology to analyse forum posts from April 2019 to January 2020 on three adolescent-based subreddits. Posts were extracted using the Baumgartner Reddit Corpus. Identifiable information was removed to protect anonymity.

RESULTS

Inductive thematic analysis identified two overarching themes, namely, public stigma and self-stigma associated with depression inauthenticity. Public stigma could be further dissected into five subthemes: (i) dichotomy between 'real' and 'fake depression'; (ii) aggression towards 'fakers'; (iii) stereotypes; (iv) attention; and (v) diagnosis. On the other hand, the theme of self-stigma consisted of subthemes: (i) self-doubt and (ii) validation and invalidation.

CONCLUSIONS

Adolescents framed a dichotomy between so-called 'real' and 'fake depression', with hostility directed at peers perceived to be 'fake depressed'. Perceptions of depression inauthenticity were confused and inconsistent. Public and self-stigma towards depression inauthenticity enforced barriers to help-seeking. While future research should investigate to what extent these observations based on online forums mimic stigma in real-life settings, our findings have highlighted the needs for 'fake depression' stigma to be addressed by adolescent depression literacy and stigma interventions. Recent movements towards reconceptualizing depression as a dimensional construct may help to challenge these stigmatizing views of a dichotomy between 'real' and 'fake' depression.

PRACTITIONER POINTS

There is widespread stigma concerning perceived inauthenticity related to depression in these online adolescent communities, with vitriol targeted at peers perceived to be so-called 'fake depressed'. Adolescent depression literacy and stigma programmes should tackle stigma towards perceived inauthenticity and promote the message that all adolescent distress deserves attention and help. This involves challenging perceptions that only supposedly 'authentic', diagnosed, or diagnosable, depression is worthy of attention and support. Prevention Programmes should work to mitigate barriers to help-seeking posed by misunderstandings that distress which is kept secret is more 'authentic', and tackle gender and age stereotypes surrounding perceived inauthenticity. There is a need for clinically approved online resources targeted at adolescents who feel unsure about whether their symptoms could be indicators of depression, and to make professional advice and help more accessible for young people.

A meta-analysis of the relationship between early maladaptive schemas and depression in adolescence and young adulthood

Early maladaptive schemas (EMS) are broad, pervasive themes and patterns of emotions, memories, cognition and physical sensations that impede the goal of individuals. Maladaptive behaviours can occur as a response to maladaptive or negative schemas, often culminating in depression or anxiety. The current meta-analysis integrates the existing literature to estimate the magnitude of effect of association between EMS and depression among adolescents and young adults. A systematic search of seven different databases including Embase, CINAHL, Medline, ASSIA, Psych INFO, Scopus and Web of Science was carried out identifying 24 relevant studies of adolescents (10-18 years) and young adults (19-29 years). The random-effect model estimate for association between overall EMS and depression was r = 0.56 (95% CI 0.49-0.63, Z = 12.88, p ≤ 0.0001), suggesting higher predominant EMS significantly linked to higher levels of depressive symptoms, with a large effect size. Separate meta-analytical results with schema domains indicated moderately stronger associations between schemas of disconnection/rejection, impaired autonomy/performance and other-directedness with depression. Age and gender were not found to have any significant moderating effect on the associations. The findings suggest that it is vital for clinicians to identify specific maladaptive schemas contributing towards depression, to have a better understanding of underlying cognitive processes and in turn promote psychological health, well-being and resilience in adolescents and young adults. Furthermore, findings will also assist clinicians to focus more on the content of three significant schema domains, which emerged as particularly salient factors underlying adolescent depression.

Secondary attachment and mental health in Pakistani and Scottish adolescents: A moderated mediation model

OBJECTIVES

Research into adolescent mental health has tended to focus on primary attachment relationships. However, the effect of secondary attachment relationships and the role of culture remain under-explored. This study examined the associations between primary attachment, secondary attachment, and coping strategies (task-focused, emotion-focused, and avoidant coping) with psychological well-being and psychological distress in adolescents across two cultural settings.

DESIGN

A cross-sectional study.

METHOD

An identical test battery was used across two geographic sites in Pakistan (N = 510; 12-18 years; 51.5% male; mean age = 14.50) and Scotland (N = 610; 12-18 years; 53.6% male; mean age = 13.97). Associations were tested separately in each sample using moderated mediation modelling for the outcome variables: psychological well-being and psychological distress.

RESULTS

For psychological well-being, all three coping strategies were significant partial mediators and secondary attachment was a significant moderator in both samples. Secondary attachment moderated the association between emotion-focused coping and psychological well-being in the Pakistani sample only. For psychological distress, task-focused coping was a significant full mediator in the Pakistani sample only. In contrast, for the Scottish sample, task-focused coping and emotion-focused coping were significant partial mediators. Secondary attachment's direct effect on psychological distress was significant in both samples. Secondary attachment also moderated the association between emotion-focused coping and psychological distress in the Pakistani sample only.

CONCLUSIONS

The cross-cultural evidence suggests that alongside primary attachment, it is important to target secondary attachment through coping strategies, in order to enhance psychological well-being and lessen psychological distress in adolescents.

PRACTITIONER POINTS

Secondary attachment plays a different role from primary attachment in adolescents. Therefore, it is important to target both primary attachment and secondary attachment security to enhance psychological well-being and lessen psychological distress. Cross-cultural differences in coping suggest that differential strategies to target different coping dimensions may enhance adolescent well-being across cultures. These cross-cultural differences highlight the ethical importance of cultural sensitivity among clinicians working with adolescents globally.

Longitudinal trajectories of brain age in young individuals at familial risk of mood disorder from the Scottish Bipolar Family Study

Background: Within young individuals, mood disorder onset may be related to changes in trajectory of brain structure development. To date, however, longitudinal prospective studies remain scarce and show partly contradictory findings, with a lack of emphasis on changes at the level of global brain patterns. Cross-sectional adult studies have applied such methods and show that mood disorders are associated with accelerated brain aging. Currently, it remains unclear whether young individuals show differential brain structure aging trajectories associated with onset of mood disorder and/or presence of familial risk. Methods: Participants included young individuals (15-30 years, 53%F) from the prospective longitudinal Scottish Bipolar Family Study with and without close family history of mood disorder. All were well at time of recruitment. Implementing a structural MRI-based brain age prediction model, we globally assessed individual trajectories of age-related structural change using the difference between predicted brain age and chronological age (brain-predicted age difference (brain-PAD)) at baseline and at 2-year follow-up. Based on follow-up clinical assessment, individuals were categorised into three groups: (i) controls who remained well (C-well, n = 93), (ii) high familial risk who remained well (HR-well, n = 74) and (iii) high familial risk who developed a mood disorder (HR-MD, n = 35). Results: At baseline, brain-PAD was comparable between groups. Results showed statistically significant negative trajectories of brain-PAD between baseline and follow-up for HR-MD versus C-well ( β = -0.60, p corrected < 0.001) and HR-well ( β = -0.36, p corrected = 0.02), with a potential intermediate trajectory for HR-well ( β = -0.24 years, p corrected = 0.06).   Conclusions: These preliminary findings suggest that within young individuals, onset of mood disorder and familial risk may be associated with a deceleration in brain structure aging trajectories. Extended longitudinal research will need to corroborate findings of emerging maturational lags in relation to mood disorder risk and onset.

Soothe ourselves in times of need: A qualitative exploration of how the feeling of 'soothe' is understood and experienced in everyday life

OBJECTIVES

Evidence suggests that self-compassion is linked to psychological benefits. Compassion-focused therapy emphasizes the importance of developing abilities to self-soothe in alleviating psychological distress. However, little is known about how the feeling of soothe is understood, experienced, and achieved in everyday life. This study addressed two research questions: (1) How is the feeling of soothe understood? (2) How is the feeling of soothe experienced in everyday life?

DESIGN

This is part of our ongoing research Project Soothe (www.projectsoothe.com), which collects soothing images from the public with the goal to develop a bank of soothing images for psychotherapeutic and research use. We also set up an online survey to explore how individuals understand and experience the feeling of soothe in everyday lives. The current study was based on the qualitative narratives obtained in this survey.

METHODS

A total of 176 participants were recruited. Data were analysed using thematic analysis.

RESULTS

Three themes emerged in response to the first research question: (1) a complex interconnected state of feelings, (2) self-soothe and being soothed, and (3) involvement of physical sensations. Five themes emerged regarding the second research question: (1) venturing out in nature, (2) being in a familiar surrounding, (3) being solitary, (4) being affiliated, and (5) being physically and mentally relaxed.

CONCLUSIONS

Our study illustrated the importance of affiliations, physical sensations, mindfulness, connection with nature, and solitude on the cultivation of soothe. Results may help develop therapeutic techniques in enhancing self-soothe by tapping into individuals' understanding and subjective experience in everyday contexts.

PRACTITIONER POINTS

Compassion-focused therapy and related third wave therapies emphasize the role of cultivating self-compassion and feelings of self-soothe in reducing psychological distress and improving mental well-being. This study sheds light on how individuals understand and achieve self-soothe in everyday life contexts. Individuals' subjective narratives suggested that both being in solitude and affiliated with others were associated with feelings of self-soothe, in addition to feeling connected with the nature, being in familiar environments and experiencing physical sensations. These findings will help practitioners develop different ways to enhance individuals' self-compassion by tapping into their understanding and experience of self-soothe in everyday life.

Longitudinal trajectories of brain age in young individuals at familial risk of mood disorder from the Scottish Bipolar Family Study

Background: Within young individuals, mood disorder onset may be related to changes in trajectory of brain structure development. To date, however, longitudinal prospective studies remain scarce and show partly contradictory findings, with a lack of emphasis on changes at the level of global brain patterns. Cross-sectional adult studies have applied such methods and show that mood disorders are associated with accelerated brain ageing. Currently, it remains unclear whether young individuals show differential brain structure aging trajectories associated with onset of mood disorder and/or presence of familial risk. Methods: Participants included young individuals (15-30 years, 53%F) from the prospective longitudinal Scottish Bipolar Family Study with and without close family history of mood disorder. All were well at time of recruitment. Implementing a structural MRI-based brain age prediction model, we globally assessed individual trajectories of age-related structural change using the difference between predicted brain age and chronological age (brain-predicted age difference (brain-PAD)) at baseline and at 2-year follow-up. Based on follow-up clinical assessment, individuals were categorised into three groups: (i) controls who remained well (C-well, n = 93), (ii) high familial risk who remained well (HR-well, n = 74) and (iii) high familial risk who developed a mood disorder (HR-MD, n = 35). Results: At baseline, brain-PAD was comparable between groups. Results showed statistically significant negative trajectories of brain-PAD between baseline and follow-up for HR-MD versus C-well ( β = -0.60, p corrected < 0.001) and HR-well ( β = -0.36, p corrected = 0.02), with a potential intermediate trajectory for HR-well ( β = -0.24 years, p corrected = 0.06).   Conclusions: These preliminary findings suggest that within young individuals, onset of mood disorder and familial risk may be associated with a deceleration in brain structure aging trajectories. Extended longitudinal research will need to corroborate findings of emerging maturational lags in relation to mood disorder risk and onset.

Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy

BACKGROUND

Pregnancy involves physiological changes in reproductive and endocrine systems, and social role changes that can increase the risk of mental health problems. In China, greater emphasis has been given to postpartum depression and its negative impact on infant development. This study examined depression in pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values, while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression.

THE AIMS OF THIS STUDY ARE TWOFOLD

First, it validated the Chinese Multidimensional Depression Assessment Scale (MDAS), a holistic self-report questionnaire measuring depression severity in four domains of depression-emotional, somatic, cognitive and interpersonal in pregnant women in Inner Mongolia; second, it examined the influences of demographic characteristics (including age, education and employment), pregnancy characteristics (week of gestation, first pregnancy), self-esteem, social support, social activity, work stress, and work-family balance on depression.

METHODS

A total of 234 pregnant women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia and self-reported questionnaires were completed.

RESULTS

Using Confirmatory factor analysis (CFA), MDAS gave rise to a best-fit four-factor model corresponding to each subscale when it was first developed. MDAS also reported high Cronbach's alpha (0.96) and good convergent validity. Using hierarchical multiple linear regressions with significant demographic variables controlled for, self-esteem, work-family conflict, and social support were found to be significant predictors for depression.

CONCLUSIONS

MDAS is a valid scale to be used with Chinese pregnant women, especially in more collectivistic geographical areas. Risk factors specific to the Chinese context add insights to the experience of antenatal depression in China and contribute to understanding depression in from a global mental health perspective.

Longitudinal trajectories of brain age in young individuals at familial risk of mood disorder

Background: Within young individuals, mood disorder onset may be related to changes in trajectory of brain structure development. To date, however, longitudinal prospective studies remain scarce and show partly contradictory findings, with a lack of emphasis on changes at the level of global brain patterns. Cross-sectional adult studies have applied such methods and show that mood disorders are associated with accelerated brain ageing. Currently, it remains unclear whether young individuals show differential brain structure ageing trajectories associated with onset of mood disorder and/or presence of familial risk. Methods: Participants included young individuals (15-30 years, 53%F) from the prospective longitudinal Scottish Bipolar Family Study with and without close family history of mood disorder. All were well at time of recruitment. Implementing a structural MRI-based brain age prediction model, we globally assessed individual trajectories of age-related structural change using the difference between predicted brain age and chronological age (brain-predicted age difference (brain-PAD)) at baseline and at 2-year follow-up. Based on follow-up clinical assessment, individuals were categorised into three groups: (i) controls who remained well (C-well, n = 93), (ii) high familial risk who remained well (HR-well, n = 74) and (iii) high familial risk who developed a mood disorder (HR-MD, n = 35). Results: At baseline, brain-PAD was comparable between groups. Results showed statistically significant negative trajectories of brain-PAD between baseline and follow-up for HR-MD versus C-well ( β = -0.60, p corrected < 0.001) and HR-well ( β = -0.36, p corrected = 0.02), with a potential intermediate trajectory for HR-well ( β = -0.24 years, p corrected = 0.06).   Conclusions: These preliminary findings suggest that within young individuals, onset of mood disorder and familial risk may be associated with a deceleration in brain structure ageing trajectories. Extended longitudinal research will need to corroborate findings of emerging maturational lags in relation to mood disorder risk and onset.

Fear of falling and emotional regulation in older adults

Objectives: Fear of falling is common amongst older adults with and without a prior experience of falling. It is related to decreased quality of life, isolation, and institutionalisation. It also poses a risk for future falls when activity is avoided because of fear of falling and muscle deconditioning occurs. Relatively little is known about the psychological factors underpinning fear of falling. This study explored the relationship between emotion regulation and fear of falling in community dwelling older adults. Method: A sample of 117 older adults (>65 years) were recruited from community based exercise classes, falls reduction classes, NHS and charity organisations. Self-reported measures included the Falls Efficacy Scale-International (FES-I), the Fear of Falling Behaviour Questionnaire (FFABQ), the Difficulties in Emotion Regulation Scale (DERS) and the Hospital and Anxiety Depression Scale (HADS). Results: A significant positive correlation was found between emotion regulation and fear of falling, as well as between emotional regulation and fear-related avoidance behaviour. A regression model found that after controlling for depression and age, emotion regulation was no longer significantly related to fear of falling. Conclusions: Fear of falling is associated with emotion regulation difficulties in community dwelling older adults. However, this link no longer exists once depression is controlled for. The key clinical implication is the importance of the assessment of depression in older adults with a fear of falling. Future research should use a longitudinal design to further unpick the causal relationships between these variables.

Thai Adolescent Depression: Recurrence Prevention in Practice

This article aims to review the current practice of recurrence prevention and intervention of adolescent depressive disorder in Thailand. In particular, we assess the Clinical Practice Guideline of Major Depressive Disorder for General Practitioners (CPG-MDD-GP) for Thailand, which is now the official guideline for all depressive patients who are children, adolescents, and adults in Thailand. Although this current Thai clinical guideline was developed and derived from the National Institute for Health and Care Excellence (NICE) of the United Kingdom and the recommendations and the practice parameters of the American Academy of Child and Adolescent Psychiatry (AACAP), it differs from these guidelines in a number of ways. Specifically, the main tool for the primary assessment of the Thai CPG-MDD-GP is called 9Q which categorizes the severity and follow-up of depressive symptoms by health care providers in a hospital setting, whereas the NICE guideline for depression in children and adolescents is based mainly on the community setting, and the AACAP parameter assesses patients by a direct interview method. Additionally, the Thai CPG-MDD-GP has no premise intervention for recurrence prevention of depression and lacks details regarding the importance of treatment engagement by family and community.

Parental bonding and adolescents' depressive and anxious symptoms in Pakistan

INTRODUCTION

A quantitative cross sectional study was carried out to investigate the role of parental bonding in relation to depressive and anxious symptoms among secondary school adolescents in Pakistan. The study also aimed to investigate the construct validity of the parental bonding inventory in the cultural context of Pakistan.

METHODS

The sample consisted of 1124 adolescents recruited from eight secondary schools in Rawalpindi, Pakistan. Urdu translated versions of Parental Bonding Instrument (Qadir et al., 2005) and Hospital Anxiety and Depression Scales (Mumford et al., 1991) were administered in classroom settings. Confirmatory factor analysis (CFA) and Structural Equation Modeling (SEM) were used to analyze the data.

RESULTS

Results from the CFA of the Urdu version of the Parental Bonding Instrument supported a modified version of the three factor model proposed by Kendler (1996) consisting of warmth, protectiveness and authoritarianism. Based on SEM, we found a significant relationship between low parental warmth and depression symptoms among adolescents, whereas maternal protectiveness was a significant predictor for anxiety. Parental authoritarianism was not a significant predictor for depression or anxiety.

DISCUSSION

Findings of this study indicate that parental bonding is a central construct within a developmental framework in the cultural context of Pakistan, and is important when considering long-term psychosocial functioning of individuals. It should be explored further in clinical populations of Pakistani adolescents to ascertain significance of these constructs for interventions.

Self-compassion and Psychological Distress in Adolescents-a Meta-analysis

Research indicates that self-compassion is relevant to adolescents' psychological well-being, and may inform the development of mental health and well-being interventions for youth. This meta-analysis synthesises the existing literature to estimate the magnitude of effect for the association between self-compassion and psychological distress in adolescents. Our search identified 19 relevant studies of adolescents (10-19 years; N = 7049) for inclusion. A large effect size was found for an inverse relationship between self-compassion and psychological distress indexed by anxiety, depression, and stress (r = - 0.55; 95% CI  - 0.61 to - 0.47). The identified studies were highly heterogeneous, however sensitivity analyses indicated that correction for publication bias did not significantly alter the pattern of results. These findings replicate those in adult samples, suggesting that lack of self-compassion may play a significant role in causing and/or maintaining emotional difficulties in adolescents. We conclude that self-compassion may be an important factor to target in psychological distress and well-being interventions for youth.

Intelligence and neuroticism in relation to depression and psychological distress: Evidence from two large population cohorts

Background

Neuroticism is a risk factor for selected mental and physical illnesses and is inversely associated with intelligence. Intelligence appears to interact with neuroticism and mitigate its detrimental effects on physical health and mortality. However, the inter-relationships of neuroticism and intelligence for major depressive disorder (MDD) and psychological distress has not been well examined.

Methods

Associations and interactions between neuroticism and general intelligence (g) on MDD, self-reported depression, and psychological distress were examined in two population-based cohorts: Generation Scotland: Scottish Family Health Study (GS:SFHS, n = 19,200) and UK Biobank (n = 90,529). The Eysenck Personality Scale Short Form-Revised measured neuroticism and g was extracted from multiple cognitive ability tests in each cohort. Family structure was adjusted for in GS:SFHS.

Results

Neuroticism was strongly associated with increased risk for depression and higher psychological distress in both samples. Although intelligence conferred no consistent independent effects on depression, it did increase the risk for depression across samples once neuroticism was adjusted for. Results suggest that higher intelligence may ameliorate the association between neuroticism and self-reported depression although no significant interaction was found for clinical MDD. Intelligence was inversely associated with psychological distress across cohorts. A small interaction was found across samples such that lower psychological distress associates with higher intelligence and lower neuroticism, although effect sizes were small.

Conclusions

From two large cohort studies, our findings suggest intelligence acts a protective factor in mitigating the effects of neuroticism on psychological distress. Intelligence does not confer protection against diagnosis of depression in those high in neuroticism.

Deactivation in anterior cingulate cortex during facial processing in young individuals with high familial risk and early development of depression: fMRI findings from the Scottish Bipolar Family Study

BACKGROUND

Studies have identified perturbations in facial processing in bipolar disorder and major depressive disorder (MDD), but their relationship to genetic risk and early development of illness is unclear.

METHODS

The Scottish Bipolar Family Study is a prospective longitudinal investigation examining young individuals (age 16-25) at familial risk of mood disorder. Participants underwent functional MRI using an implicit facial processing task employing angry and neutral faces. An explicit facial expression recognition task was completed outside the scanner. Clinical outcomes obtained 2 years after the scan were used to categorise participants into controls (n = 54), high-risk individuals who had developed MDD (HR MDD; n = 30) and high-risk individuals who remained well (HR Well, n = 43).

RESULTS

All groups demonstrated activation patterns typically observed during facial processing, including activation of the amygdala, hippocampus, fusiform gyrus and middle frontal regions. Notably, the HR MDD group showed reduced activation of the anterior cingulate gyrus versus both the control and HR Well group for angry faces, and versus the HR Well group for neutral faces. Outside the scanner, the HR MDD group was less accurate in recognising fearful expressions than the HR Well group.

CONCLUSIONS

Here, we demonstrate functional abnormalities of the anterior cingulate cortex alongside facial emotional recognition deficits in high-risk individuals in the early stages of depression compared with both controls and at-risk individuals who remained well. These neural changes were associated with a current or future diagnosis of MDD and were not simply associated with increased familial risk.

Prospective longitudinal voxel-based morphometry study of major depressive disorder in young individuals at high familial risk

BACKGROUND

Previous neuroimaging studies indicate abnormalities in cortico-limbic circuitry in mood disorder. Here we employ prospective longitudinal voxel-based morphometry to examine the trajectory of these abnormalities during early stages of illness development.

METHOD

Unaffected individuals (16-25 years) at high and low familial risk of mood disorder underwent structural brain imaging on two occasions 2 years apart. Further clinical assessment was conducted 2 years after the second scan (time 3). Clinical outcome data at time 3 was used to categorize individuals: (i) healthy controls ('low risk', n = 48); (ii) high-risk individuals who remained well (HR well, n = 53); and (iii) high-risk individuals who developed a major depressive disorder (HR MDD, n = 30). Groups were compared using longitudinal voxel-based morphometry. We also examined whether progress to illness was associated with changes in other potential risk markers (personality traits, symptoms scores and baseline measures of childhood trauma), and whether any changes in brain structure could be indexed using these measures.

RESULTS

Significant decreases in right amygdala grey matter were found in HR MDD v. controls (p = 0.001) and v. HR well (p = 0.005). This structural change was not related to measures of childhood trauma, symptom severity or measures of sub-diagnostic anxiety, neuroticism or extraversion, although cross-sectionally these measures significantly differentiated the groups at baseline.

CONCLUSIONS

These longitudinal findings implicate structural amygdala changes in the neurobiology of mood disorder. They also provide a potential biomarker for risk stratification capturing additional information beyond clinically ascertained measures.

Hippocampal volume in vulnerability and resilience to depression

BACKGROUND

Reduced hippocampal volume has been associated with clinical depression. However, it remains unclear whether these changes are a biological vulnerability marker or a consequence of this disorder. METHODS AND RESULTS (STUDY 1): We first compared hippocampal volumes between (i) never-depressed individuals with elevated risk for depression by virtue of high neuroticism (ii) recovered depressed individuals with matched levels of neuroticism; and (iii) individuals with low neuroticism and no history of depression. We replicated the finding of reduced hippocampal volume in the recovered group; unexpectedly however, the never-depressed high-risk group showed an increase in volume. One hypothesis is that this group had a mean age above the typical onset age for depression; hence, these participants who have remained euthymic despite their personality risk might in fact possess some resilience. METHODS AND RESULTS (STUDY 2): A subsequent study was therefore carried out to compare hippocampal volume between high-neurotic vs. low-neurotic volunteers in a younger sample. No group difference was found.

LIMITATIONS

The present findings are limited by a small sample size; the cross-sectional design precluded us from makineg definitive conclusions about causal effect.

CONCLUSION

Our overall results suggest that reduced hippocampal volumes is a neural marker for the scar effect of depression, although this structural impairment could also be seen as a vulnerability marker for the development of future recurrent episodes. By contrast, larger hippocampal volumes could be a biological marker of resilience. These findings have clinical implications regarding treatment development for the prevention of illness onset and recurrent depressive episodes.

Is cognitive bias modification training truly beneficial for adolescents?

BACKGROUND

Cognitive Bias Modification (CBM) has been shown to change interpretation biases commonly associated with anxiety and depression and may help ameliorate symptoms of these disorders. However, its evidence base for adolescents is scarce. Previous results have been hard to interpret because of methodological issues. In particular, many studies have used negative bias training as the control condition. This would tend to inflate any apparent benefits of CBM compared to a neutral control. Most studies also only examined the effects of a single training session and lacked follow-up assessment or ecologically valid outcome measures.

METHOD

Seventy-four adolescents, aged 16-18 years, were randomised to two sessions of CBM training or neutral control. Interpretation bias and mood were assessed three times: at baseline, immediately post-training and 1 week post-training. A controlled experimental stressor was also used, and responses to everyday stressors were recorded for 1 week after training to assess responses to psychological challenges. Feedback for the training programme was collected.

RESULTS

The CBM group reported a greater reduction in negative affect than control participants. However, other hypothesised advantages of CBM were not demonstrated. Regardless of training group, participants reported increased positive interpretations, decreased negative interpretations, reduced depressive symptoms and no change in trait anxiety. The two groups did not differ in their stress reactivity. After controlling for group differences in training performance, all the mood effects disappeared.

CONCLUSIONS

When tested under stringent experimental conditions the effects of CBM in healthy adolescents appear to be minimal. Future studies should concentrate on participants with elevated cognitive biases and/or mood symptoms who may be more sensitive to CBM.

Prospective study to validate HpOne in the diagnosis of Helicobacter pylori infection

INTRODUCTION

The HpOne test is a new five-minute rapid urease test developed for the rapid detection of Helicobacter pylori infection during gastroscopy. However, evidence in the literature supporting its use clinically is scarce. The most commonly used rapid urease test remains the Campylobacter-like organism (CLO) test, which generates accurate readings only after 24 hours. The aim of this study was to evaluate the efficacy of the HpOne test in our local population.

METHODS

From August 2007 to May 2008, consecutive patients undergoing gastroscopy for various indications were recruited into this prospective study. Patients who were pregnant, lactating, on proton pump inhibitors, antibiotics, immunosuppressants or had previous gastric surgery were excluded. During gastroscopy, six gastric mucosal biopsies were taken; three from the body and three from the antrum. One body and one antral biopsy were used for each of the HpOne test, CLO test and histology. Results of the HpOne and CLO tests were then compared against the gold standard of histology.

RESULTS

Of the 149 patients recruited, 82 (55 percent) were men and 67 (45 percent) were women. The prevalence of Helicobacter pylori infection was 38.9 percent (n is 58). The sensitivity and specificity of the HpOne test were 65.5 percent and 85.7 percent, respectively, while those for the CLO test were 63.8 percent and 84.6 percent, respectively.

CONCLUSION

The HpOne test is as efficacious as the CLO test, with the added advantage of yielding results faster. It is thus a superior alternative and should be considered for clinical use.

Cognitive bias modification training in adolescents: effects on interpretation biases and mood

BACKGROUND

Negative biases in the interpretation of ambiguous material have been linked to anxiety and mood problems. Accumulating data from adults show that positive and negative interpretation styles can be induced through cognitive bias modification (CBM) paradigms with accompanying changes in mood. Despite the therapeutic potential of positive training effects, training paradigms have not yet been explored in adolescents.

METHODS

Eighty-two healthy adolescents (aged 13-17 years) were randomly allocated to either positive or negative CBM training. To assess training effects on interpretation bias, participants read ambiguous situations followed by test sentences with positive or negative interpretations of the situation. Participants rated the similarity of these sentences to the previously viewed ambiguous situations. Training effects on negative and positive affect were assessed using visual analogue scales before and after training.

RESULTS

After training, adolescents in the negative condition drew more negative and fewer positive interpretations of new ambiguous situations than adolescents in the positive condition. Within the positive condition, adolescents endorsed more positive than negative interpretations. In terms of mood changes, positive training resulted in a significant decrease in negative affect across participants, while the negative condition led to a significant decrease in positive affect among male participants only.

CONCLUSION

This is the first study to demonstrate the plasticity of interpretation bias in adolescents. The immediate training effects on mood suggest that it may be possible to train a more positive interpretation style in youth, potentially helping to protect against anxiety and depressive symptoms.

Risk for depression and neural responses to fearful facial expressions of emotion

BACKGROUND

Depression is associated with neural abnormalities in emotional processing.

AIMS

This study explored whether these abnormalities underlie risk for depression.

METHOD

We compared the neural responses of volunteers who were at high and low-risk for the development of depression (by virtue of high and low neuroticism scores; high-N group and low-N group respectively) during the presentation of fearful and happy faces using functional magnetic resonance imaging (fMRI).

RESULTS

The high-N group demonstrated linear increases in response in the right fusiform gyrus and left middle temporal gyrus to expressions of increasing fear, whereas the low-N group demonstrated the opposite effect. The high-N group also displayed greater responses in the right amygdala, cerebellum, left middle frontal and bilateral parietal gyri to medium levels of fearful v. happy expressions.

CONCLUSIONS

Risk for depression is associated with enhanced neural responses to fearful facial expressions similar to those observed in acute depression.

Highly neurotic never-depressed students have negative biases in information processing

BACKGROUND

Cognitive theories associate depression with negative biases in information processing. Although negatively biased cognitions are well documented in depressed patients and to some extent in recovered patients, it remains unclear whether these abnormalities are present before the first depressive episode.

METHOD

High neuroticism (N) is a well-recognized risk factor for depression. The current study therefore compared different aspects of emotional processing in 33 high-N never-depressed and 32 low-N matched volunteers. Awakening salivary cortisol, which is often elevated in severely depressed patients, was measured to explore the neurobiological substrate of neuroticism.

RESULTS

High-N volunteers showed increased processing of negative and/or decreased processing of positive information in emotional categorization and memory, facial expression recognition and emotion-potentiated startle (EPS), in the absence of global memory or executive deficits. By contrast, there was no evidence for effects of neuroticism on attentional bias (as measured with the dot-probe task), over-general autobiographical memory, or awakening cortisol levels.

CONCLUSIONS

These results suggest that certain negative processing biases precede depression rather than arising as a result of depressive experience per se and as such could in part mediate the vulnerability of high-N subjects to depression. Longitudinal studies are required to confirm that such cognitive vulnerabilities predict subsequent depression in individual subjects.