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This study evaluated the role of bidirectional micro- and macro- level positive affect-related processes in the longitudinal coupling of depressive symptoms in parent-adolescent dyads. Using a measurement-burst design, including dyadic experience sampling methods (ESM) and monthly follow-ups over one year, this work investigated associations between (1) parental depressive symptoms and anhedonia and parental daily-life enhancing and dampening responses to youth positive affect; (2) parental daily-life enhancing and dampening and trajectories of youth positive affect, negative affect, and depressive symptoms across one year; and (3) youth developmental trajectories and prospective parental daily-life enhancing and dampening, and parental depressive symptoms and anhedonia at one-year follow-up. Participants included 146 early adolescents (52.1% girls, 47.9% boys; Mage[SD] = 12.71[.86]) and 139 parents (78.7% mothers; Mage[SD] = 44.11[5.08]). Parental enhancing and dampening were measured using a dyadic ESM procedure at baseline and 12-months. Youth completed monthtly questionnaires assessing depressive symptoms and trait positive and negative affect across 12 months. Parents reported on depressive symptoms and anhedonia at baseline and 12-months. Results showed that parental anhedonia negatively related to parental daily-life enhancing, and youths’ perceptions of their parents’ enhancing and dampening reciprocally related to youth emotional development across one year, with downstream implications for parents’ own symptoms of depression.
Cognitive behavioural therapy (CBT) and medication are widely accepted and useful interventions for individuals with depression. However, a gap remains in our current understanding of how CBT directly benefits adolescents with depression.
Aims:
The purpose of this study was to examine the short- and long-term effectiveness of CBT only, CBT+Medication, or Medication alone in reducing the duration of major depressive episodes, lessening internalizing and externalizing symptoms and improving global functioning.
Methods:
Data were extracted from 14 unique studies with a total of 35 comparisons. Network meta-analysis was conducted and p-scores, a measure of the extent of certainty that one treatment is better than another, were used to rank treatments.
Results:
There was no significant difference between any two treatments for depression, nor internalizing or externalizing symptoms. For global functioning, CBT had significantly greater effect at the longest follow-up than CBT+Medication. CBT+Medication had the highest p-score for depression, short- and long-term effects, and internalizing and externalizing symptoms long-term effects. No indication of publication bias was found.
Conclusions:
Neither modality, CBT nor medication, is superior for treating adolescent depression. However, CBT was superior in improving global functioning, which is essential for meeting developmental goals.
Although it is well known that parental depression is transmitted within families across generations, the etiology of this transmission remains unclear. Our goal was to develop a novel study design capable of explicitly examining the etiologic sources of intergenerational transmission. We specifically leveraged naturally-occurring variations in genetic relatedness between parents and their adolescent children in the 720 families participating in the Nonshared Environment in Adolescent Development (NEAD) study, 58.5% of which included a rearing stepparent (nearly always a stepfather). Results pointed squarely to the environmental transmission of psychopathology between fathers and children. Paternal depression was associated with adolescent depression and adolescent behavior problems (i.e., antisocial behavior, headstrong behavior, and attention problems) regardless of whether or not fathers and their children were genetically related. Moreover, these associations persisted to a subset of “blended” families in which the father was biologically related to one participating child but not to the other, and appeared to be mediated via father–child conflict. Such findings are not only fully consistent with the environmental transmission of psychopathology across generations, but also add to extant evidence that parent–child conflict is a robust and at least partially environmental predictor of adolescent psychopathology.
The relationships between offspring depression profiles across adolescence and different timings of parental depression during the perinatal period remain unknown.
Aims
To explore different timings of maternal and paternal perinatal depression in relation to patterns of change in offspring depressive mood over a 14 year period.
Method
Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Parental antenatal depression (ANTD) was assessed at 18 weeks gestation, and postnatal depression (PNTD) at 8 weeks postpartum. Population-averaged trajectories of offspring depressive symptoms were estimated using the Short Mood and Feelings Questionnaire (SMFQ) on nine occasions between 10 and 24 years of age.
Results
Full data were available for 5029 individuals. Offspring exposed to both timings of maternal depression had higher depressive symptoms across adolescence compared with offspring not exposed to ANTD or PNTD, characterised by higher depressive symptoms at age 16 (7.07 SMFQ points (95% CI = 6.19, 7.95; P < 0.001)) and a greater rate of linear change (0.698 SMFQ points (95% CI = 0.47, 0.93; P = 0.002)). Isolated maternal ANTD and to a lesser extent PNTD were also both associated with higher depressive symptoms at age 16, yet isolated maternal PNTD showed greater evidence for an increased rate of linear change across adolescence. A similar pattern was observed for paternal ANTD and PNTD, although effect sizes were attenuated.
Conclusions
This study adds to the literature demonstrating that exposure to two timings of maternal depression (ANTD and PNTD) is strongly associated with greater offspring trajectories of depressive symptoms.
There is growing evidence of an escalation of depression in young people. In light of this, schools are increasingly being confronted with the challenge of how to best manage students with depressive disorders. Such management includes consideration of the academic, behavioural, social and emotional implications of the disorder. This article provides school practitioners and management with a review of what constitutes ‘best practice’ in school management of students with depressive disorders. It adopts the mental health intervention framework of the Institute of Medicine, considering how school-based intervention occurs across the four domains of mental health promotion, prevention, case identification and treatment, as well as maintenance of students with or at-risk of depression. It provides a checklist for practitioners at each stage of the Institute of Medicine intervention spectrum. Moreover, it takes the view that best practice in psychology is always evidence-based practice, although discerning a clear path through the available research is not always obvious.
Adolescent depression has been shown to have a range of adverse outcomes. We used longitudinal data to investigate subsequent higher education in former depressed adolescents.
Method
A Swedish population-based investigation of depression in 16–17-year-olds was followed up in national registers 15 years later. Adolescents with depression (n = 361, 78% females) were compared to a group of non-depressed peers of the same age (n = 248, 77% females). The main outcome was graduation from higher education by age 30.
Results
The adolescent with depression were less likely than their non-depressed peers to have graduated from higher education by age 30, both regarding females (27.7% vs. 36.4%, p < .05) and males (12.7% vs. 28.6%, p < .05). After adjustment for early school performance, socioeconomic status and maternal education, the decreased likelihood of subsequent graduation from higher education remained for depressed males (OR, 0.27; 95% CI, 0.08–0.93) but not for depressed females (OR, 0.93; 95% CI, 0.58–1.49).
Conclusion
Contrary to what previous research has suggested, adolescent depression and its consequences might be particularly destructive to subsequent higher education in males.
Mitochondrial dysfunction has been increasingly examined as a potential pathogenic event in psychiatric disorders, although its role early in the course of major depressive disorder (MDD) is unclear. Therefore, the purpose of this study was to investigate mitochondrial dysfunction in medication-free adolescents with MDD through in vivo measurements of neurometabolites using high-spatial resolution multislice/multivoxel proton magnetic resonance spectroscopy.
Methods
Twenty-three adolescents with MDD and 29 healthy controls, ages 12–20, were scanned at 3 T and concentrations of ventricular cerebrospinal fluid lactate, as well as N-acetyl-aspartate (NAA), total creatine (tCr), and total choline (tCho) in the bilateral caudate, putamen, and thalamus were reported.
Results
Adolescents with MDD exhibited increased ventricular lactate compared to healthy controls [F(1,41) = 6.98, P = 0.01]. However, there were no group differences in the other neurometabolites. Dimensional analyses in the depressed group showed no relation between any of the neurometabolites and symptomatology, including anhedonia and fatigue.
Conclusions
Increased ventricular lactate in depressed adolescents suggests mitochondrial dysfunction may be present early in the course of MDD; however it is still not known whether the presence of mitochondrial dysfunction is a trait vulnerability of individuals predisposed to psychopathology or a state feature of the disorder. Therefore, there is a need for larger multimodal studies to clarify these chemical findings in the context of network function.
Fluoxetine is generally regarded as the first-line pharmacological treatment for young people, as it is believed to show a more favourable benefit:risk ratio than other antidepressants. However, the mechanisms through which fluoxetine influences symptoms in youth have been little investigated. This study examined whether acute administration of fluoxetine in a sample of young healthy adults altered the processing of affective information, including positive, sad and anger cues.
Method
A total of 35 male and female volunteers aged between 18 and 21 years old were randomized to receive a single 20 mg dose of fluoxetine or placebo. At 6 h after administration, participants completed a facial expression recognition task, an emotion-potentiated startle task, an attentional dot-probe task and the Rapid Serial Visual Presentation. Subjective ratings of mood, anxiety and side effects were also taken pre- and post-fluoxetine/placebo administration.
Results
Relative to placebo-treated participants, participants receiving fluoxetine were less accurate at identifying anger and sadness and did not show the emotion-potentiated startle effect. There were no overall significant effects of fluoxetine on subjective ratings of mood.
Conclusions
Fluoxetine can modulate emotional processing after a single dose in young adults. This pattern of effects suggests a potential cognitive mechanism for the greater benefit:risk ratio of fluoxetine in adolescent patients.
The objective of this review is to summarise the evidence for mindfulness and acceptance approaches in the treatment of adolescent depression. The article begins by summarising the outcomes of three broad approaches to the treatment of adolescent depression — primary prevention, pharmacotherapy, and psychotherapy — in order to advocate for advances in treatment. With regard to psychotherapy, we restrict this to comparisons of meta-analytic studies, in order to cover the breadth of the outcome literature. In the second half of this article, we introduce the reader to mindfulness and acceptance-based psychotherapy, with a particular focus on Acceptance and Commitment Therapy (ACT) and the applicability with adolescents. We provide an overview of the philosophical arguments that underlie this approach to psychotherapy and consider how each of these might contribute to treatment approaches for adolescents with depression.
An increasing body of research in support of cognitive-behavioural therapy (CBT) for adolescent depression has emerged during the last two decades. However, it has been suggested that empirically supported treatments are seldom carried out in clinical practice. Although the reasons for this are likely to be diverse, it is argued that mental health services have an ethical responsibility to offer evidence-based interventions. Whether empirically supported interventions, such as CBT, are consistently offered to depressed adolescents attending Child and Adolescent Mental Health Services (CAMHS) is currently unknown. A primary aim of this study was to survey the use of CBT for depression in a number of United Kingdom (UK) CAMHS settings. A postal questionnaire was sent to 117 members of the BABCP Children, Adolescents and Families Special Interest Branch, of which 44 completed questionnaires were returned. Descriptive statistics indicate that just over half of the organizations represented routinely offered CBT to depressed adolescents. CBT practice and the transportation of evidence-based research findings to CAMHS settings are discussed.
In this article I review the changes in thinking about childhood depression since the 1950s, with an emphasis on the struggles to find language for childhood depression. My interface with these changes is described, with a particular focus on the development of the Children's Depression Scale (CDS). Clinical applications of family therapy using the CDS in treatment of childhood depression are then illustrated with a composite case example. The idea is developed that depression in children can be seen as a blocked communication, and that increasing emotional expressiveness in families is an appropriate therapeutic aim and intervention. The relevance of the historical context to current practice is considered.
Depression in childhood and adolescence is a chronic, recurring, and highly morbid disorder associated with poor psychosocial functioning, suffering, and attempted and completed suicide. This chapter throws light on how to diagnose depression in children and adolescents. It explores how the clinical picture of depression changes between childhood and adulthood, and focuses on ways people can adapt interviewing techniques for children. The information that the parent conveys helps to structure the interview with the child and helps efficiently and completely to elicit symptoms from the child. Reliability on the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS) and other instruments suggests that the diagnosis of depression in children and adolescents could be made as reliably as these diagnoses are made in adults. Discussing psychopharmacologic treatment, the chapter highlights that for medication, a selective serotonin reuptake inhibitor (SSRI) is most likely the first choice.
Based on a behavior-analytic interpretation of the skills acquisition process, a rationale is presented for augmenting a currently available cognitive-behavioral treatment (The Adolescent Coping With Depression course: CWD-A) with a newly developed therapy focusing on the interpersonal interactions and learning occurring in-session (Learning through In-Vivo Experience: LIVE). A description of the practice of LIVE is offered and the results from an initial feasibility study are presented. Using a single-subject methodology, two groups each consisting of 5 adolescents with significant symptoms of depression received the treatment. The intervention consisted of 16 2-hour group sessions occurring over an 8-week period. The first 1-hour of each meeting was taken directly from the CWD-A manual. The second hour was based on the LIVE manual. The adolescents who completed the treatment (n = 8) improved from pretreatment to posttreatment and those who discontinued treatment (n = 2) did not. Improvements were maintained at 3 months follow-up. The treatment produced strong group cohesion and both adolescents and their guardians rated the intervention positively. These results provide initial evidence of the efficacy of complementing CWD-A with LIVE.
All childhood and adolescent depression can be characterized as 'refractory' if the measurement used is scientific evidence of efficacious treatments. There have been a small number of systematic studies reported examining the efficacy of psychotherapy interventions for child and adolescent depression. Treatment resistance is a difficult concept to operationalize in young populations, and may apply to a substantial proportion of children and adolescents who are seen clinically. It is clearly established that pediatric major depression is a valid diagnostic entity which as clinical continuity with adult affective disorders. Potential for overdose is a significant concern in the treatment of mood disordered children and adolescents. Selective serotonin reuptake inhibitors (SSRIs) have a very low potential of lethality, while the lethality of tricyclic antidepressants (TCAs) is very high. SSRIs have potential drug-drug interactions with thioridazine, TCAs, and terfenadine.
This chapter examines five issues of childhood and adolescent depression that consider the interplay between continuity and risk. The first focuses on the rate of various forms of depression in the childhood and adolescence years. The second tracks the physiological concomitants and possible predictors of depression among the physiological changes that characterize early adolescence. The third is regarding the timing and sequencing of biopsychosocial changes in the first half of adolescence. The fourth concerns family history and rearing environment. Finally the fifth looks at what is known about continuity between clinical depression and less severe forms of depressed affect, especially as the study of physiological processes might shed light on this most important aspect of continuity. Research suggests that a high degree of comorbidity occurs between depression and other mental disorders and research on psychological mechanisms considers both clinical depression and depressed affect.
Neuroendocrine studies of adolescent depression are still in their early formative years. This chapter reviews the current literature on various neuroendocrine studies in adolescent depression. It summarizes relevant physiological information about various endocrine systems and succinctly reviews selected adult findings in similar areas of investigation to highlight similarities and differences to adolescent studies in findings where they occur. Growth hormone (GH) release from the pituitary is regulated by the interplay of the neurotransmitters, either by direct hypothalamic action or through their effect on intermediate compounds such as growth hormone-releasing hormone (GHRH) or somatostatin. The hypothalamic-pituitary-growth hormone (HPGH) axis provides a good model for evaluating CNS functioning. Studies of adult depressives have shown blunted ACTH responses to CRH regardless of serum cortisol levels. Neurotransmitter regulation of melatonin secretion is complicated and not fully understood. Further research into the multiple aspects of serotonergic functioning should be a priority in future development.
Cognitive behavioural approaches have been used in the treatment of
adult depression for many years, with much evidence of effectiveness. The
paper discusses issues in the applicability of these techniques in
interventions with depressed children and adolescents. Different models
of CBT are discussed and a typical programme described using a case
example. Work with parents, carers and other significant adults is
emphasised.
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