Adolescent Depressive Symptoms Research Articles

Early Literature on Adolescent Social Media Use, Substance Use, and Depressive Symptoms During the COVID-19 Pandemic: A Scoping Review

Early Literature on Adolescent Social Media Use, Substance Use, and Depressive Symptoms During the COVID-19 Pandemic: A Scoping Review

Overparenting and psychological wellbeing among Chinese adolescents: Findings based on latent growth modeling.

Although overparenting is a growing phenomenon across the globe, there is a severe lack of longitudinal studies examining the trajectory of overparenting and its effects on early adolescent development, particularly in non-Western contexts. The study collected three waves of longitudinal data from 1328 early Chinese adolescents in Hong Kong with an interval of 1 year to examine the stability and change of perceived paternal and maternal overparenting and their effects on adolescent psychological wellbeing. The results indicated that perceived paternal and maternal overparenting declined over time. Besides, adolescents reported lower anxiety and depressive symptoms when they perceived a steep decline in maternal overparenting. Adolescent anxiety at earlier time points also predicted a steeper decline in paternal and maternal overparenting trajectories respectively. Furthermore, we identified gender differences in the initial level of paternal overparenting and the trajectory of maternal overparenting, as well as the effects of rates of change of maternal overparenting on adolescent anxiety and depressive symptoms. The findings give support for self-determination theory and the separation-individuation model, suggesting that changes of overparenting may hinder adolescents' desires for autonomy and self-direction, which may increase their psychological morbidity. The study contributes to theoretical development of contemporary Chinese socialization models and provides useful pointers for future studies of overparenting.

Parent and adolescent depressive symptom among a nationally representative sample of Chinese families: The chained mediating roles of parental involvement and parent–child attachment

ObjectivesThis study aimed to examine the relationships between paternal and maternal depressive symptoms and adolescent depressive symptoms. Subsequently, the study investigated the chained mediating effects of parental involvement and parent–child attachment. MethodsAs part of the national survey in China, fathers, mothers, and adolescents from 700 families across the country were included in this study. Fathers and mothers reported their depressive symptoms and parental involvement, while adolescents rated the level of paternal attachment, maternal attachment, and depressive symptoms. ResultsPaternal depressive symptoms were related to adolescent depressive symptoms through the mediation effect of paternal attachment, maternal attachment, the chained mediating effects of paternal involvement and paternal attachment, and the chained mediating effects of paternal involvement and maternal attachment. Maternal depressive symptoms were related to adolescent depressive symptoms through the mediating effect of paternal attachment, maternal attachment, the chained mediating effects of paternal involvement and paternal attachment, the chained mediating effects of paternal involvement and maternal attachment, the chained mediating effects of maternal involvement and paternal attachment, and the chained mediating effects of maternal involvement and maternal attachment. Additionally, both paternal and maternal depressive symptoms were significantly directly related to adolescent depressive symptoms. Overall, maternal depressive symptoms had a greater impact on adolescent depressive symptoms than paternal depressive symptoms. ConclusionsThe findings support the impacts of parental depressive symptoms on child depressive symptoms through the mediating effects of parental involvement and parent–child attachment. This study provides targeted recommendations for intervention programs.

Association between allergic diseases, generalized anxiety disorder, and depressive symptoms in South Korean adolescents: a secondary data analysis of the 2022 Korea Youth Risk Behavior Survey.

This study investigated the relationship between allergic diseases, general anxiety disorder, and depressive symptoms among Korean adolescents. A secondary analysis was conducted on the findings of the 18th Korea Youth Risk Behavior Survey (2022). The study included 51,850 adolescents and analyzed the relationships among allergic diseases, general anxiety disorder, and depressive symptoms using complex samples logistic regression analysis. Among the Korean adolescents, 12.7% experienced general anxiety disorder, while 28.7% experienced depressive symptoms. The prevalence of allergic diseases was 5.7% for asthma, 36.3% for allergic rhinitis, and 22.2% for atopic dermatitis. General anxiety disorder was associated with asthma and allergic rhinitis but not atopic dermatitis. Depressive symptoms were associated asthma, allergic rhinitis, and atopic dermatitis. Examining the correlation among allergic diseases, general anxiety disorder, and depressive symptoms in adolescents underscores the need for implementing suitable strategies. Moreover, when addressing general anxiety disorder and depressive symptoms in adolescents, it becomes crucial to consider the presence of allergic diseases.

0812 Modelling the Impact of Reallocating Sleep and Physical Activity on Anxiety and Depression Symptoms in Adolescents

0812 Modelling the Impact of Reallocating Sleep and Physical Activity on Anxiety and Depression Symptoms in Adolescents

The association between academic achievement goals and adolescent depressive symptoms: a prospective cohort study in Australia.

Students define academic competence across two axes: developing skills and understanding (mastery) versus comparisons with peers (performance), and achieving goals (approach) versus avoiding failure (avoidance). We aimed to examine the longitudinal association between achievement goals and adolescent depressive symptoms. We analysed data from the Kindergarten (recruited at age 4-5 years; born between March, 1999, and February, 2000; recruited from March, 2004 to November, 2004) and Baby (recruited at age 0-1 years; born between March, 2003, and February, 2004; recruited from March, 2004 to January, 2005) cohorts of the Longitudinal Study of Australian Children. Participants were identified through the Medicare enrolment database and sampled using a randomised selection stratified by postcode to represent the Australian population. Achievement goals were measured at age 12-13 years with the Achievement Goal Questionnaire (ranges from 1 to 7 on each of the four subscales), and depressive symptoms with the Short Mood and Feelings Questionnaire (score ranges from 0 to 26, with higher scores indicating more severe symptoms) at ages 14-15 years (both cohorts) and 16-17 years (Kindergarten cohort only). Analyses were linear multilevel and traditional regressions, with confounder adjustment, for participants with available data on the exposures, confounders, and outcome. We included 3200 participants (1585 female and 1615 male) from the Kindergarten cohort and 2671 participants (1310 female and 1361 male) from the Baby cohort. A 1-point increase in mastery-approach goals was associated with decreased depressive symptom severity score (Kindergarten, -0·33 [95% CI -0·52 to -0·15]; Baby, -0·29 [-0·54 to -0·03]), while a 1-point increase in mastery-avoidance goals was associated with increased depressive symptom severity score (Kindergarten, 0·35 [95% CI 0·21 to 0·48]; Baby, 0·44 [0·25 to 0·64]). A 1-point increase in performance-avoidance goals was associated with increased depressive symptom severity score in the Kindergarten cohort but not the Baby cohort (Kindergarten, 0·26 [95% CI 0·11 to 0·41]; Baby, -0·04 [-0·27 to 0·19]). We found little evidence of an association between depressive symptom severity and performance-approach goals. Depressive symptoms in adolescents were associated with their achievement goals, which could be targetable risk factors for future trials to investigate whether school-based interventions that aim to enhance factors consistent with mastery goals (ie, learning skills and understanding the subject, rather than assessing competence in comparison to peers) could prevent depression in adolescents. Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society.

How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children.

This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.Data were analyzed from 3089 children followed between Waves 1 (age 4-5 years) and 7 (16-17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16-17. Anxiety and depressive symptoms were measured using the Children's Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16-17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35-56) and 21% of depressive symptoms (95% CI: 12-29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11-25%) of anxiety and 15% (95% CI: 4-25%) of depressive symptoms at age 16-17 years were attributable to parental psychological distress experienced between the ages of 4-15 years.The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.

Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom.

Youth adversity is associated with persistence of depression and anxiety symptoms. This association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g. males). Given that persistent symptoms are observed across a range of disadvantaged, minoritized, and neurodivergent groups (e.g. low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. Data from HeadStart Cornwall (N = 4441) was used to assess the effect of youth adversity on combined symptoms of depression and anxiety (Strengths and Difficulties Questionnaire emotional problems subscale) measured at three time-points in 11-14-year-olds. Latent trajectories and regressions were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention), and moderating effects of the individual characteristics and their intersections were estimated. Youth adversity was associated with higher average depression/anxiety symptoms at baseline (11-12-years) across all intersectionality profiles. The magnitude of effects differed across profiles, with suggestive evidence for a moderating effect of youth adversity on change over time in depression/anxiety symptoms attributable to the intersection between (i) gender and SES; and (ii) gender, SES, and hyperactivity/inattention. The detrimental effects of youth adversity pervade across intersectionality profiles. The extent to which these effects are moderated by intersectionality is discussed in terms of operational factors. The current results provide a platform for further research, which is needed to determine the importance of intersectionality as a moderator of youth adversity on the development of depression and anxiety symptoms in adolescence.

Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis.

Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents.We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis.Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria.BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.

Anxiety and depression symptoms in adolescents and young adults with juvenile idiopathic arthritis: results of an outpatient screening

BackgroundPrevious studies have shown that growing up with rheumatic conditions can fuel dissatisfaction and psychological distress, which in turn affects disease self-management and treatment adherence. Primary objective of this study was to estimate the prevalence of anxiety and depression symptoms in adolescents and young adults (AYA) with juvenile idiopathic arthritis (JIA) and to identify correlates of conspicuous screening results.MethodsInitiated as part of the COACH multicenter observational study, outpatients aged 12 to 21 years participating in the National Pediatric Rheumatological Database (NPRD) were prospectively screened for mental health using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder Scale-7 (GAD-7).ResultsData from 1,150 adolescents with JIA (mean age 15.6 ± 2.2 years; mean disease duration 7.2 ± 4.9 years, 69% female, 43% oligoarthritis, 26% polyarthritis) were analysed. Overall, 32.7% (n = 316) of AYA showed conspicuous screening results, of whom 30.4% reported clinically relevant suicidal or self-harm thoughts. About 19% of screened patients showed moderate to severe depressive or anxious symptoms. AYA with conspicuous screening results were older (15.8 vs. 15.2 years; p < 0.0001), more often female (81% vs. 64%; p < 0.0001) and more often overweight (25% vs. 17%; p = 0.006). They had higher disease activity (physician global assessment on NRS 0–10; 1.7 vs. 1.2; p < 0.0001), more functional limitations (CHAQ; 0.44 vs. 0.14; <0.0001) and rated their health status worse (NRS 0–10; 3.5 vs. 1.8; p < 0.0001) than AYA with inconspicuous screening results. Females (OR 2.33 [CI 1.53–3.56]; p < 0.0001), older age (OR 1.09 [CI 1.01–1.18]; p = 0.026), patients with more functional limitations (OR 3.36 [CI 1.98–5.72]; p < 0.0001), and patients with worse subjective health status (OR 1.17 [CI 1.07–1.27]; p < 0.0001) were more likely to have a conspicuous screening result. Regular sports participation was associated with a lower likelihood of conspicuous screening result (OR 0.69 [CI 0.49–0.98]; p = 0.039).ConclusionsA large-scale outpatient screening of AYA with JIA in Germany shows a high prevalence of anxiety and depression symptoms. The need for routine screening for early detection of mental health problems became apparent.

Chronic unpredictable mild stress increases serum aldosterone without affecting corticosterone levels and induces hepatic steatosis and renal injury in young adult male rats.

Stress is often associated with anxiety and depressive symptoms in adolescents. Stress is associated with components of metabolic syndrome and inflammation. The present study hypothesizes that aldosterone, more than corticosterone, promotes chronic stress-hepatic steatosis and fibrosis, as well as renal inflammation and fibrosis in young adult rats. Thirty-two young adult male Wistar rats of 51 days old were divided into four groups (n = 8 per group): Control (C), chronic unpredictable mild stress (CUMS), control plus vehicle (C plus veh), CUMS plus eplerenone, a selective aldosterone blocker (CUMS plus EP). On postnatal day 51, eplerenone was administered orally through a gastric tube two hours before the start of the stress test. The CUMS paradigm was administered once daily at different times, with no repetition of the stressor sequence for four weeks. Renal inflammation and fibrosis were measured, as well as liver glycogen, triacylglycerol, and fibrosis levels. The serum concentrations of corticosterone, aldosterone, sodium, and creatinine were measured in urine and serum. The CUMS group showed a high level of serum aldosterone without affecting the level of corticosterone, increased urinary sodium, tubular atrophy, glomerular sclerosis, the presence of inflammation, and fibrosis, without affecting creatinine, increased glycogen content, triacylglycerol, and moderate fibrosis in the liver, and treatment with eplerenone prevented the inflammation, fibrosis, glycogen, and triacylglycerol. Our results show that chronic stress-induced aldosterone promotes hepatic steatosis and renal injury more than corticosterone. The prevention by eplerenone supports our hypothesis.

Secular trends in risk factors for adolescent anxiety and depression symptoms: the Young-HUNT studies 1995-2019, Norway.

In recent decades, increases in mental health problems in adolescents have been reported from several large population-based surveys. This raises questions about changes in underlying risk and protective factors that can inform future intervention strategies. Population data were collected from 1995 to 2019 in three waves of the Young-HUNT studies in Norway to map decennial trends in the prevalence of established risk factors for, and their associations with, adolescent mental health problems. All adolescents (aged 13-19years) attending lower and upper secondary school in the county of Trøndelag were invited, representing three historical cohorts of 25,245 unique adolescents. Mental health problems (HSCL-5) and established mental health risk factors were self-reported. Using a generalized linear model and linear regression, we calculated changes in relative and absolute differences between risk factors and mental health problems. Overall, the prevalence of established risk factors for mental health problems in adolescence increased markedly between 1995 and 2019, especially in girls. Prominent increases were observed for fatigue, bullying, musculoskeletal pain and migraine, loneliness, and overweight. Furthermore, with the exception of excess alcohol use and family economy, associations between each risk factor and adolescent mental health problems strengthened over the same time span in girls, but less among boys. Our findings suggest that several modifiable risk factors for poor mental health in adolescence are increasing, especially among girls, and should be targeted in community, school, and in clinical settings.

The Relationship Between Childhood Trauma and Non-Suicidal Self-Injury Behavior in Adolescents with Depression: The Mediating Role of Rumination.

Non-suicidal self-injury (NSSI) behavior is very common in adolescents with depression, and childhood trauma is considered one of the distal risk factors for its exacerbation. Rumination caused by adverse traumatic experiences, which can be transferred through NSSI behavior, can alleviate symptoms of depression in adolescents. The current research focuses on the relationship between the three, further exploring whether rumination is a mediator in the relationship between childhood trauma and NSSI behavior on the basis of previous studies, and provides some suggestions for future early intervention for adolescents with depression. A total of 833 adolescent patients with depression who met the DSM-5 criteria for depressive episode were recruited from 12 hospitals in China. The Chinese version of the Function Assessment of Self-mutilation, Childhood Trauma Questionnaire, and Rumination Inventory were used as research tools. The scores of childhood trauma and rumination in adolescents with depression in the NSSI group were higher than those in the non-NSSI group. A Pearson's correlation analysis showed that childhood trauma was positively correlated with rumination (r=0.165, P<0.01), different types of childhood trauma were significantly positively correlated with rumination and its three factors, and these results were statistically significant. Rumination partially mediated the relationship between childhood trauma and NSSI behavior in depressed adolescent patients (effect size=0.002), and the effect in female participants (effect size=0.003), was greater than that in male participants (effect size=0.002). Childhood trauma and rumination were key factors for NSSI behavior in adolescents with depression. Childhood trauma not only has a direct effect on NSSI behavior in adolescent depression, but also plays an indirect effect on NSSI behavior through rumination.

Adolescent Depression: Impact of Family Relations

Depression is a major mental disorder that affects numerous people and causes them to experience depressive episodes. The root of depression usually appears in people’s teenage years. Research have shown that family relations, in particular, has the largest impact on the development and manifestation of depressive symptoms in teenagers. After reviewing pertinent literature, the specific components in family relations that are risk factors and protective factors for depressive symptoms in adolescents are identified. The risk factors for depressive symptoms in teenagers are mostly correlated with negative family emotions and actions, which includes parental criticism and expressed emotions, parental depression, lack of family cohesion and adaptability, lack of parental care, negative family emotional climate, and lack of physical affection and verbal intimacy. The protective factors revolve around adolescents’ ability to recognize and manage negative emotions, which includes emotion regulation, positive family climate and social support, emotion coaching, emotion clarity, and cooperative communication. Four recommendations for parents are offered based on these observed risk factors and protective factors to hinder and prevent the development of depression adolescents. These recommendations are social support, positive family atmosphere, physical affection, and verbal affection. It is hoped that studies in the future can focus on investigating the effectiveness of these recommendations and provide a more detailed and reliable list of recommendations for parents to reduce the chances of depression development in their children.

A longitudinal investigation of the cross-dimensional mediating role of negative life events between neuroticism and depressive symptoms in adolescents

BackgroundNeuroticism has been identified as a significant predictor for depression within the adolescent population However, few longitudinal studies have investigated this association and explored the mediation effect of the negative life events. This study aimed to examine the longitudinal association between neuroticism, negative life events, and depression in a large sample of Chinese adolescents. MethodsData on Five Factor Inventory-Neuroticism Subscale (FFI-N) was collected from 1150 participants aged 14–19 years old at baseline, and data on Adolescent Life Event Questionnaire (ALEQ) and Center of Epidemiological Study-Depression (CES-D) were collected both at baseline and 6-month follow-up. Multilevel modelings were used to analyze the longitudinal associations among neuroticism, negative life events and depression. ResultsThrough a longitudinal study design, results from multilevel regression analyses indicated a direct correlation between increased levels of neuroticism and the aggregation of negative life events with the prediction of more severe depressive symptoms. Further, results of multilevel mediations suggested that the negative life events served to partially mediate the relationship between neuroticism and each dimension of depression. LimitationsThe results cannot be used to make a clinical diagnosis. ConclusionThe current findings suggest the negative life events as a cross-dimensional mediator in the relationship between neuroticism and each dimension of depression. Regulating neuroticism levels and implementing strategies to coping stress derived from daily life events could be integral approaches to reducing the prevalence of depression within the adolescent population.

Effects of Pollution Burden on Neural Function During Implicit Emotion Regulation and Longitudinal Changes in Depressive Symptoms in Adolescents

BackgroundExposure to environmental pollutants early in life has been associated with increased prevalence and severity of depression in adolescents; the neurobiological mechanisms underlying this association are not well understood. In the current longitudinal study, we investigated whether pollution burden in early adolescence (9-13 years) is associated with altered brain activation and connectivity during implicit emotion regulation and with changes in depressive symptoms across adolescence. Methods145 participants (N=87 females; 9-13 years) provided residential addresses, from which we determined their relative pollution burden at the census-tract level, and performed an implicit affective regulation task in the scanner. Participants also completed questionnaires assessing depressive symptoms at three timepoints, each approximately two years apart, from which we calculated within-person slopes of depressive symptoms. We conducted whole-brain activation and connectivity analyses to examine whether pollution burden is associated with alterations in brain function during implicit emotion regulation of positively- and negatively-valenced stimuli, and how these effects are related to slopes of depressive symptoms across adolescence. ResultsGreater pollution burden was associated with greater bilateral medial prefrontal cortex (MPFC) activation and stronger bilateral MPFC connectivity with regions within the default mode network (DMN; e.g., temporoparietal junction, posterior cingulate cortex, precuneus) during implicit regulation of negative emotions, which was associated with greater increases in depressive symptoms across adolescence in those exposed to higher pollution burden. ConclusionsAdolescents living in communities characterized by greater pollution burden showed altered DMN functioning during implicit regulation of negative emotions that was associated with increases in depressive symptoms across adolescence.

초기 청소년이 지각한 부모애착이 우울증상에 미치는 영향: 자율성과 자아존중감의 다중매개효과

초기 청소년이 지각한 부모애착이 우울증상에 미치는 영향: 자율성과 자아존중감의 다중매개효과

Effectiveness of Combined Treatment of Transcranial Direct Current Stimulation and Treatment as Usual on Depression, Anxiety and Anger in Adolescents with Bipolar Disorder

Objectives: Bipolar disorder (BD) is a prevalent psychological disorder associated with depressive symptoms. Transcranial direct current stimulation (tDCS) is a portable and non-invasive technique for brain stimulation. The present study was conducted to determine the effectiveness of the combined treatment of tDCS and routine medication on the symptoms of depression, anxiety, and anger in BD adolescents. Methods: In this double-blind randomized clinical trial study, forty adolescents with BD referred to the outpatient clinic of child and psychiatry of Golestan Ahvaz Teaching Hospital were included. Eligible patients aged 12 - 18 years were randomly divided into 2 groups receiving routine medications plus active tDCS (intervention group) or routine medications plus sham tDCS (control group). Transcranial direct current stimulation intervention with an intensity of 2 mA was applied to the dorsolateral prefrontal cortex in two sessions for 20 minutes each day, for 5 consecutive days. Data were collected at baseline, one week, and one month after the start of the intervention using the Hamilton Depression Rating Scale (HDRS-21), Hamilton Anxiety Rating Scale (HDRS), and State-Trait Anger Expression Inventory. Results: Based on our findings, age and gender were not considerably different between the two groups (P = 0.592, P = 0.1, respectively). In both groups, scores of depression (control: 12.25 ± 3.97, intervention: 0.75 ± 1.44, mean [SD]), anxiety (13.55 ± 2.58, 25.0 ± 0.55), and anger (52.65 ± 8.27, 47.25 ± 4.86) improved significantly one month after treatment (P &lt; 0.0001). After one month of treatment, the severity of bipolar symptoms in the intervention group (slightly: 10%, moderately: 50%, and markedly: 40%) improved significantly compared to the control group (slightly: 15%, moderately: 10%, and markedly: 0%) (P &lt; 0.0001). The improvement rate of HDRS in the intervention group was 81.29% and 95.24% at one week and one month after treatment, while these values were 8.41% and 23.04% in the control group, respectively (P &lt; 0.0001). All patients tolerated the treatment well without serious side effects. There was no significant difference between the side effects observed in both groups (P = 0.185). Conclusions: The combination of tDCS with routine medications can reduce depressive symptoms and improve bipolar symptoms. Therefore, tDCS add-on could be an effective, safe, and tolerable intervention for bipolar depression.

The role of maternal emotional expressivity in maternal marital satisfaction and adolescents' depressive symptoms among Chinese families: Moderated by family socioeconomic status

The present study aims to investigate the complex interplay among three family factors: maternal marital satisfaction, maternal emotional expressivity, and family socioeconomic status, and their impact on adolescent depression in Chinese families. A total of 542 Chinese adolescents and their mothers from diverse socioeconomic backgrounds completed the survey. The data revealed that higher maternal marital satisfaction correlated with more positive emotional expressivity and less negative emotional expressivity. Both types of maternal emotional expressivity were associated with depressive symptoms in adolescents. Moreover, both maternal positive and negative emotional expressivity mediated the relationship between maternal marital satisfaction and adolescents’ depressive symptoms. Notably, the mediating role of maternal negative expressivity was only evident when the family’s socioeconomic status was moderate to high. These findings underscore the important role played by maternal emotional expressivity and family socioeconomic status in the dyadic processes between the marital relationship of mothers and the emotional well-being of adolescents in Chinese families. The present study also indicates potential targets for parenting interventions aimed at promoting the mental health of adolescents.

Precision computerised cognitive behavioural therapy (cCBT) for adolescents with depression: a pilot and feasibility randomised controlled trial protocol for SPARX-UK

BackgroundA serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context.AimsTo conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable.MethodsFollowing consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11–19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8–10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention.DiscussionThe findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK’s health services if delivered en masse.Trial registrationISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804.