Adolescent Depressed Mood Research Articles

Tracking of depressed mood from adolescence into adulthood and the role of peer and parental support: A partial test of the Adolescent Pathway Model

•Adolescent depressed mood predicts adult depressed mood.•Peer acceptance during adolescence is not associated with adult depressed mood.•Household income moderates the effect of parental closeness on adult depressed mood.

The adolescent HIV executive function and drumming (AHEAD) study, a feasibility trial of a group drumming intervention amongst adolescents with HIV

ABSTRACT AHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drumming programme aiming to improve executive function, depression and anxiety symptoms, and perceived social support in adolescents living with HIV in a rural low-income South African setting. Sixty-eight 12- to 19-year-old adolescents participated. They were individually randomised. The intervention arm (n = 34) received weekly hour-long group drumming sessions. Controls (n = 34) received no intervention. Feasibility and acceptability were assessed using rates of: enrolment; retention; attendance; logistical problems; adolescent-reported acceptability. Secondary measures included: five Oxford Cognitive Screen-Executive Function (OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; the Self-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; the Multidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were within green progression limits. Enrolment, retention, and acceptability were high. There was a positive effect on adolescent depressed mood with signal for a working memory effect. There were no significant effects on executive function or socio-emotional scales. Qualitative findings suggested socio-emotional benefits including: group belonging; decreased internalised stigma; improved mood; decreased anxiety. Group drumming is a feasible and acceptable intervention amongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.

Mental health of agricultural adolescents and adults: Preliminary results of a five-year study.

Work-related stressors common to agriculture have been associated with adverse mental health outcomes among adult farmers and ranchers. However, the mental health status of agricultural youth is unknown, despite farm and ranch youth being exposed to the same occupational hazards as their adult counterparts. The objective of this study was to estimate the prevalence of symptoms of depression and anxiety among farm adults and their adolescent child and examine the correlation between symptoms of mental health conditions and financial indicators described in the Family Stress Model (FSM). Farm families were recruited to participate in online surveys by mail, email, and social media. One adolescent and at least one adult from each family were invited to complete on online survey. Where available, validated instruments were used to collect mental health, stress, family dynamics, and household financial variables. Descriptive statistics were used to describe sample demographics and prevalence of symptoms of depression and anxiety. Pearson correlations describe associations between variables within the Family Stress Model. Farm families (N = 122) completed the online survey. The mean age of farm parents was 41.4 years (SD = 4.4) and the mean age of farm adolescents was 15.4 (1.2). A majority of farm parents and farm adolescents were male, 58.2% and 70.5%, respectively. The sample was primarily white, non-Hispanic. In this sample of farm parents and adolescents alike, 60% met the criteria for at least mild depression, based on the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-A (PHQ-A). Similarly, among adolescents, 45.1% met the criteria for Generalized Anxiety Disorder (GAD), as did 54.9% of adults. As a measure of economic hardship, per capita income by itself showed relatively low correlations, even with other economic measures (r = 0.11 with negative financial events, r = 0.20 with financial needs, r = 0.17 with financial situation, and r = 0.27 with debt). Parent depressed mood was in turn highly associated with adolescent depression (r = 0.83), social anxiety (r = 0.54), and generalized anxiety (r = 0.69). The results show a strong association between parent and adolescent mental health and parental depressed mood and debt. There is not a clear association between economic stress and mental health in this sample, but further work is needed to be done at a population level. Preliminary results are promising for application of the full Family Stress Model as we continue to accrue farm families into the study cohort.

Intersecting identities and adolescent depression: Patterns of depressed mood and anhedonia in the past decade

BackgroundResearch suggests adolescent depression is increasing and certain adolescents may be uniquely vulnerable. However, limited conceptualizations of identity and time, as well as the reliance on unitary conceptualizations of depression, inhibits a nuanced perspective on these trends. In response, we examined how adolescent depressive symptoms, depressed mood, and anhedonia, vary across intersecting identities over time. MethodsSecondary data analysis on the National Survey on Drug Use and Health between 2009 and 2017 was conducted. In total 145,499 nationally representative adolescents (ages 12–17) completed a diagnostic assessment for depression. Lifetime and past year reports of depressive symptoms, depressed mood, and anhedonia were treated as separate variables. A novel, mixed-level model in which participants were nested within identity (defined by one's age, gender, race/ethnicity, poverty level) and time was used to test our aims. ResultsOverall, the relation between depression outcomes and identity did not vary over time (p > .01). Further, identity's impact on depression was approximately ten-fold that of temporal effects. Multiracial, late adolescent, female adolescents were at particular risk. Findings concerning depressed mood and anhedonia were similar across analyses. LimitationsAll facets of identity (e.g., sexual identity) were not included in the model and a unidimensional measure of poverty may have underestimated its depressogenic influence. ConclusionAdolescent depression outcomes are mostly consistent across criterial symptom subtypes and time, but vary as a function of identity. Prevention protocols that highlight mechanisms of risk tethered to social identity, and include salient experiences of females, late adolescents, and multiracial youth in particular, need to be prioritized in mental health initiatives.

Adolescent depressed mood and difficulties with emotion regulation: Concurrent trajectories of change

IntroductionAdolescent depression is a significant mental health concern. Emotion regulation difficulties have been associated with subsequent depressive symptoms, though different facets of emotion regulation are rarely compared. This study examined the degree to which trajectories of change in different facets of emotion regulation (goal-directed behavior, impulse control, and regulation strategies) and depressive symptoms were associated across twelve months in a clinical adolescent sample. MethodsParticipants included 110 adolescents from the US who were enrolled in a randomized trial that tested a cognitive-behavioral treatment for youth with co-occurring mental health and substance use concerns (Mage = 15.71 years; 57.3% male). Assessments were conducted at baseline, 3-, 6-, and 12-month follow-ups. Three separate bivariate latent basis growth curve analyses were conducted. Correlations between latent intercepts and latent slopes, as well as overall model fit, were examined. ResultsImpulse control and goal-directed behavior were each associated with depressive symptoms at baseline. Additionally, change in impulse control over time was significantly associated with change in depressive symptoms. However, the same was not true for goal-directed behavior. Overall fit indices for models of emotion regulation strategies were below acceptable levels and thus could not be interpreted. ConclusionsFindings from the present study indicate that adolescents’ depressive symptoms appear to improve as their perceived ability to control impulses improves. These results suggest that addressing impulse control difficulties may be an important step in treating adolescent depression and co-occurring disorders.

The role of social support in differentiating trajectories of adolescent depressed mood

IntroductionThis study explored the extent to which disaggregated support from family, peers, close friendships, teachers, and schools predicted membership into identified, sex-specific trajectories of depressed mood in 3210 Australian adolescents (49% females) based on self-report data collected at four annual time points from school Grade 6 to 9 (ages 10–16). MethodsThe sample was initially split by sex. Group-Based Trajectory Modelling was used to identify the trajectory groups using a Censored Normal model, starting with a two-group model and increasing group size in increments of one, up to a six-group model. Overall model-fit and specific model-fit criteria were examined, and participants were allocated to best-fit groups. Multinomial Logistic Regression examined the associations between baseline social supports and allocated trajectory group membership. ResultsFor boys, four trajectory groups were identified which were given the qualitative labels; Low Stable, Moderate Stable, Moderate Decreasing, and High Stable. Regression analysis showed that higher rates of peer belonging were associated with membership in the low and moderate groups compared to the High Stable group. For girls, four trajectory groups were identified and labelled as Low Stable, Moderate Decreasing, Moderate Increasing and High Increasing. Regression analysis showed that higher rates of family support, school climate, and peer belonging were associated with membership in the low and moderate groups compared to the High Increasing group. ConclusionsImplications included the need for school-based early intervention programs to consider disaggregated supports and vary their interventions by sex. Limitations and directions for future research are discussed.

Implications of Family Cohesion and Conflict for Adolescent Mood and Well-Being: Examining Within- and Between-Family Processes on a Daily Timescale.

Family-level conflict and cohesion are well-established predictors of adolescent mental health. However, traditional approaches focusing on between-family differences in cohesion and conflict may overlook daily intrafamily variability that might provide important new information. We used data from a 21-day daily diary protocol in a sample of 151 caregivers (95.3% female) and their adolescent child (61.5% female) in two-caregiver families to test whether daily changes in family functioning are associated with daily changes in adolescent well-being and whether adolescent well-being depends on average levels of family functioning. We examined family cohesion and conflict in relation to adolescent angry, depressed, and anxious mood, as well as happiness, life satisfaction, and meaning and purpose in life in multilevel models. Both cohesion and conflict exhibited meaningful daily variation. Adolescent-reported cohesion and conflict had unique within-family associations with all six adolescent outcomes. Models using parent reports of family functioning yielded fewer associations than models with adolescent reports; however, several findings remained. Cross-level interactions indicated that within-family variations in cohesion were only associated with adolescent depression in families with lower average levels of cohesion across days. In sum, this study provides compelling evidence that families exhibit meaningful variability from day to day and that daily variation has important implications for adolescent well-being.

Parental monitoring protects against the effects of parent and adolescent depressed mood on adolescent drinking

ObjectiveParental monitoring is a well-established protective factor for adolescent drinking. This study examined whether parental monitoring protected against three common risk factors for alcohol use in a sample of high-risk adolescents: parental depressed mood, adolescent depressed mood, and parental alcohol use. MethodsParticipants included 117 adolescents (mean age=15.5; 52% female) who presented to the hospital emergency department due to an alcohol-related event and their primary parent/guardian. Adolescents completed self-report measures of alcohol use frequency, depressed mood, and parental monitoring, while parents completed self-report measures of problematic alcohol use and depressed mood. ResultsHierarchical regression confirmed that parental monitoring was associated with lower frequency of adolescent alcohol use, even after controlling for the three risk factors. Significant interactions were found between parental monitoring and both adolescent and parental depressed mood. Parental monitoring had significant protective effects against drinking frequency among adolescents with higher levels of depressed mood, but not among adolescents with lower levels of depressed mood. By contrast, parental monitoring only had protective effects among those parents with lower levels of depressed mood. Parental problematic alcohol use did not affect the relationship between parental monitoring and adolescent alcohol use. ConclusionsOur results suggest that adolescents with high levels of depressed mood may be more likely to benefit from parental monitoring, whereas parents with high levels of depressed mood may be less likely to monitor effectively. Interventions targeting parental monitoring in high-risk adolescents should take into account the influence of both adolescent and parental depressed mood.

Intra- and Inter-Individual Differences in Adolescent Depressive Mood: the Role of Relationships with Parents and Friends

Utilizing four waves of data from 1126 secondary school Dutch adolescents (Mage = 13.95 at the first wave; 53% boys), the current study examined the interplay between parent-adolescent and friend-adolescent relationship quality (satisfaction and conflict) in relation to adolescents’ depressive mood. Using multilevel analyses, the interacting effects of parent/friend relationship quality on depressive mood were tested at both the intra- and inter-individual level. Analyses at the intra-individual level investigated whether individual depressive mood fluctuated along with changes in their social relationships regardless of one’s general level of depressive mood; and analyses at the inter-individual level examined whether the average differences in depressive mood between adolescents were associated with different qualities of social relationships. We interpreted the patterns of interactions between parent and friend relationships using four theoretical models: the reinforcement, toxic friends, compensation, and additive model. The results demonstrate the covariation of parent- and friend- relationship quality with adolescents’ depressive mood, and highlight that parent and peer effects are not independent from each other—affirming the compensation and additive models at the intra-individual and the reinforcement and additive models at the inter-individual level. The findings highlight the robustness of the protective effects of parent and peer support and the deleterious effects of conflictual relationships for adolescent mental health. The results have implications for both the theoretical and practical design of (preventive) interventions aimed at decreasing adolescents’ depressive mood.

Risky dieting amongst adolescent girls: Associations with family relationship problems and depressed mood

ObjectiveThis study examined the association of risky dieting amongst adolescent girls with depressed mood, family conflict, and parent-child emotional closeness. MethodGrade 6 and 8 females (aged 11–14years, N=4031) were recruited from 231 schools in 30 communities, across three Australian States (Queensland, Victoria, and Western Australia). Key measures were based on the Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used short measures of family relationship quality. Controls included age, early pubertal onset, and socioeconomic status. ResultsRisky dieting was significantly related to family conflict and depressed mood, depressed mood mediated the association of family conflict and risky dieting, and these associations remained significant with controls in the model. ConclusionFamily conflict and adolescent depressed mood are associated with risky dieting. ImplicationsPrevention programs may benefit from a broadening of behavioural targets to include depressed mood and family problems.

Concurrent Treatment of Depression in Parents and Adolescents: A Case Example

The detrimental influence of parent psychopathology—and depression, in particular—on adolescent mental health has been well documented. Routes of transmission include both direct and indirect factors, such as poor parent–adolescent communication, ineffective parenting practices, modeling ineffective coping skills, increased family discord and stress, inadvertent reinforcement of adolescent depressed mood and suicidal ideation and behavior, and decreased treatment adherence. This paper introduces a novel treatment to concurrently treat both a depressed adolescent as well as a depressed parent. This approach improves upon traditional cognitive-behavioral therapy by targeting relational factors of each adolescent–parent dyad while simultaneously addressing each individual’s depression. Principles of case conceptualization and treatment planning using this novel approach are illustrated using a case example.

Depressed Mood During Early to Middle Adolescence: A Bi-national Longitudinal Study of the Unique Impact of Family Conflict

Adolescent depressed mood is related to the development of subsequent mental health problems, and family problems have been linked to adolescent depression. Longitudinal research on adolescent depressed mood is needed to establish the unique impact of family problems independent of other potential drivers. This study tested the extent to which family conflict exacerbates depressed mood during adolescence, independent of changes in depressed mood over time, academic performance, bullying victimization, negative cognitive style, and gender. Students (13years old) participated in a three-wave bi-national study (n=961 from the State of Washington, United States, n=981 from Victoria, Australia; 98% retention, 51% female in each sample). The model was cross-lagged and controlled for the autocorrelation of depressed mood, negative cognitive style, academic failure, and bullying victimization. Family conflict partially predicted changes in depressed mood independent of changes in depressed mood over time and the other controls. There was also evidence that family conflict and adolescent depressed mood are reciprocally related over time. The findings were closely replicated across the two samples. The study identifies potential points of intervention to interrupt the progression of depressed mood in early to middle adolescence.

Concurrent treatment for adolescent and parent depressed mood and suicidality: feasibility, acceptability, and preliminary findings.

The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE. The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.

Early Childhood Precursors and Adolescent Sequelae of Grade School Peer Rejection and Victimization

This study examined the early childhood precursors and adolescent outcomes associated with grade school peer rejection and victimization among children oversampled for aggressive-disruptive behaviors. A central goal was to better understand the common and unique developmental correlates associated with these two types of peer adversity. There were 754 participants (46% African American, 50% European American, 4% other; 58% male; average age=5.65 at kindergarten entry) followed into seventh grade. Six waves of data were included in structural models focused on three developmental periods. Parents and teachers rated aggressive behavior, emotion dysregulation, and internalizing problems in kindergarten and Grade 1 (Waves 1–2); peer sociometric nominations tracked “least liked” and victimization in Grades 2, 3, and 4 (Waves 3–5); and youth reported on social problems, depressed mood, school adjustment difficulties, and delinquent activities in early adolescence (Grade 7, Wave 6). Structural models revealed that early aggression and emotion dysregulation (but not internalizing behavior) made unique contributions to grade school peer rejection; only emotion dysregulation made unique contributions to grade school victimization. Early internalizing problems and grade school victimization uniquely predicted adolescent social problems and depressed mood. Early aggression and grade school peer rejection uniquely predicted adolescent school adjustment difficulties and delinquent activities. Aggression and emotion dysregulation at school entry increased risk for peer rejection and victimization, and these two types of peer adversity had distinct as well as shared risk and adjustment correlates. Results suggest that the emotional functioning and peer experiences of aggressive-disruptive children deserve further attention in developmental and clinical research.

The impact of sleep on adolescent depressed mood, alertness and academic performance

The present study developed and tested a theoretical model examining the inter-relationships among sleep duration, sleep quality, and circadian chronotype and their effect on alertness, depression, and academic performance. Participants were 385 adolescents aged 13–18 years (M = 15.6, SD = 1.0; 60% male) were recruited from eight socioeconomically diverse high schools in South Australia. Participants completed a battery of questionnaires during class time and recorded their sleep patterns in a sleep diary for 8 days. A good fit was found between the model and the data (χ2/df = 1.78, CFI = .99, RMSEA = .04). Circadian chronotype showed the largest association with on adolescent functioning, with more evening-typed students reporting worse sleep quality (β = .50, p < .001) and diminished alertness (β = .59, p < .001). Sleep quality was significantly associated with poor outcomes: adolescents with poorer sleep quality reported less sleep on school nights (β = −.28, p < .001), diminished daytime alertness (β = .33, p < .001), and more depressed mood (β = .47, p < .001). Adolescents with poor sleep quality and/or more evening chronotype were also more likely to report worse grades, through the association with depression. Sleep duration showed no direct effect on adolescent functioning. These results identified the importance of two lesser-studied aspects of sleep: circadian chronotype and sleep quality. Easy-to-implement strategies to optimize sleep quality and maintain an adaptive circadian body clock may help to increase daytime alertness, elevate mood, and improve academic performance.

‘I Know I Can Help You’: Parental Self‐efficacy Predicts Adolescent Outcomes in Family‐based Therapy for Eating Disorders

Family-based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family-based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent-related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family-based therapy as well as the role of parental self-efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty-nine adolescents and their parents completed a series of measures at assessment, at 3-month post-assessment and at 6-month follow-up. Results indicate that, throughout treatment, parents experienced an increase in self-efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self-efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family-based therapy model and add to the literature on possible mechanisms of change in the context of family-based therapy.

Early Adolescent Depressive Mood: Direct and Indirect Effects of Attributional Styles and Coping

The present study used a cross-sectional survey design to examine how adolescent depressive mood was related to attributional styles and coping strategies with a sample of 326 youths (aged 8-14years). With the cutting point adopted in the West, 20.9% of the current sample reported depressive symptoms. Regression analysis results show that, with the asymptomatic group, seeking social support strategy mediated the effects of positive-global and positive-stable attribution, and internalization strategy mediated the effects of negative-global attribution on depression mood. In the dysphoric adolescents, attributing positive events to global factors and seeking social support strategy predicted depressive mood in the negative direction whereas attributing negative events to global factors, problem solving strategy and internalization strategy, the positive direction. The current study confirmed that both attributional styles and coping strategies were significant predictors of depressive mood but different dimensions of attribution related to depressive symptoms in different magnitude.

Early Adolescents' Goals and Mothers' Accuracy in Predicting Adolescent Goals in the Context of Type 1 Diabetes

The study examined content of adolescent goals and mothers' awareness of these goals in the context of type 1 diabetes management. Adolescents and their mothers independently reported short-term goals for the adolescent, which were coded into domains. Mothers predicted whether the goal they rated as most important would also be reported by their adolescent, and coders verified the accuracy of mothers' judgments. Mothers' accuracy was associated with less adolescent depressed mood. When mothers' accuracy reflected mother–adolescent agreement that the goal was important and being pursued by the adolescent, this positive accuracy was associated with less adolescent depressed mood, fewer problems with diabetes, and maternal acceptance. Results emphasize the importance of considering the social nature of goals in mother–adolescent relationships and diabetes management.

Predicting adolescent substance use: The effects of depressed mood and positive expectancies

This study examined whether sixth-graders' depressed mood and positive substance use expectancies predicted increases over the next two years in students' lifetime and 30-day cigarette, alcohol, and marijuana use, and whether sixth graders' positive substance use expectancies moderated the relationship between baseline depressed mood and changes over the next two years in the use of these substances. Study data came from a randomized controlled trial of Project ALERT, a school-based substance use prevention program, in which students from 34 schools completed self-report surveys as sixth (n = 5782), seventh (n = 5065), and eighth graders (n = 4940). Primary analyses were performed using Hierarchical Nonlinear Modeling. Over time, there were significant effects of baseline positive expectancies on each of the six measures of substance use. Baseline depressed mood predicted increases over time only for lifetime use of cigarettes and alcohol, and for 30-day alcohol use. Positive expectancies significantly moderated the effects of adolescent depressed mood only on lifetime marijuana use. Although depressed mood predicted substance use for half of our variables, our results suggest that positive expectancies are a more consistent predictor of adolescent substance use, and that they may moderate the effects of depressed mood on marijuana, but not cigarette or alcohol, use. Substance use prevention programs may benefit from addressing adolescents' perceptions about the positive consequences of drug use.

Self-assessed parental depressive problems are associated with blunted cortisol responses to a social stress test in daughters. The TRAILS Study

Depression runs in families and is considered a stress-related disorder. Familial risk for depression may be transmitted via deregulated psychophysiological stress responses from parent to child. In this study, we examined the association between self-assessed lifetime parental depressive problems (PDP) and adolescent offspring' cortisol responses to a social stress test. Data were collected as part of the third assessment wave of TRAILS (TRacking Adolescents' Individual Lives Survey), a large prospective population study of Dutch adolescents. Data of 330 adolescents (mean age 16.04; 40.9% girls) who participated in a laboratory session, including a standardized performance-related social stress task (public speaking and mental arithmetic) were examined. Four saliva cortisol samples were collected before, during and after the social stress task which were analyzed with repeated measures Analysis of Variance. Lifetime parental depressive problems were assessed by self-reports from both biological parents. PDP was associated with daughter' cortisol responses (F(3,133)=3.90, p=.02), but no association was found in sons (F(3,193)=0.27, p=.78). Girls whose parents ever experienced depressive symptoms displayed a blunted cortisol response to the standardized social stress test, while girls whose parents never had such problems displayed the characteristic curvilinear response pattern. This effect was not mediated by offspring stress history (age 0-16). Analyses were corrected for smoking behaviour and adolescent depressed mood. The fact that PDP were measured by self-report questionnaires and did not reflect clinical DSM-IV diagnosis could be considered a limitation of the study.