Course Of Adolescent Depression Research Articles

Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling.

BackgroundFamily history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi‐informant design to examine whether a child’s FHD adds information about future depressive episodes and depression severity applying state‐of‐the‐art predictive out‐of‐sample methodology.MethodsWe examined data in adolescents with current or past depression (age 11–17 years) from the National Institute of Mental Health Characterization and Treatment of Adolescent Depression (CAT‐D) study. We asked whether a history of depression in a first‐degree relative was predictive of depressive episode duration (72 participants) and future depressive symptom severity in probands (129 participants, 1,439 total assessments).ResultsFamily history of depression, while statistically associated with time spent depressed, did not improve predictions of time spent depressed, nor did it improve models of change in depression severity measured by self‐ or parent‐report.ConclusionsFamily history of depression does not improve the prediction of the course of depression in adolescents already diagnosed with depression. The difference between statistical association and predictive models highlights the importance of assessing predictive performance when evaluating questions of clinical utility.

When should we intervene in adolescent depression and with whom?

When should we intervene in adolescent depression and with whom?

The antecedents and outcomes of persistent and remitting adolescent depressive symptom trajectories: a longitudinal, population-based English study

Depression often first emerges in adolescence and, for many, is a lifelong disorder. The long-term clinical course of depression is highly variable. We aimed to examine the adult outcomes of adolescent-onset trajectories of clinically significant depressive symptoms and to identify factors differentiating trajectories that persist and desist in adulthood. We included participants from the English population-based Avon Longitudinal Study of Parents and Children with data on depressive symptoms. Self-reported depression symptoms were assessed on ten occasions when participants were age 10·5-25 years using the short Mood and Feelings Questionnaire, and major depressive disorder episodes were assessed at age 13·0 years, 15·0 years, 17·5 years, and 25·0 years. We characterised trajectories of depression symptoms using latent class growth analysis, for which we required depression data at least once from each of three key phases: ages 10·5-13·5 years; 16·5-18·5 years; and 21-25 years. We examined adult outcomes by assessing lifetime suicidal self-harm and functional impairment at age 24·0 years, and employment, education, and the self-reported Strengths and Difficulties Questionnaire at age 25·0 years. We studied 4234 participants: 2651 (63%) female, 1582 (37%) male, and one individual with missing sex data. The mean age was 10·6 years (SD 0·2) at baseline and 25·8 years (SD 0·5) at the final timepoint. Data on ethnicity were not available in our data set. We identified four depression trajectory classes: adolescent-persistent depression with onset early in adolescence (7%, n≈279), adolescent-limited depression with onset later in adolescence and remittance by adult life (14%, n≈592), adult-increasing depression (25%, n≈1056), and stable-low levels of depression (54%, n≈2307). The adolescent-persistent class was associated with poor adult outcomes for functional impairment (62%), suicidal self-harm (27%), mental health difficulties (25%), and not being in education, employment, or training (16%). Adolescent-limited depression was associated with transient adolescent stress, but by early adulthood functional impairment and mental health difficulties were similar to the stable-low group. Major depressive disorder polygenic score (odds ratio [OR] 1·36, 95% CI 1·04-1·79), adolescent educational attainment (OR 0·47, 0·30-0·74), and any early childhood adversity (OR 2·60, 1·42-4·78), that persisted into adulthood (OR 1·60, 1·38-1·87) distinguished the adolescent-persistent and adolescent-limited groups. The future course of adolescent depression can be differentiated by age at onset during adolescence, adolescent academic attainment, early and persistent adversity, and genetic loading. A detailed social and educational history could be helpful in making clinical decisions about the intensity of interventions for young people with clinically elevated depressive symptoms who seek help. Medical Research Council, Wolfson Centre for Young People's Mental Health, Wolfson Foundation.

Activity/rest rhythm of depressed adolescents undergoing therapy: case studies.

Disorders of circadian rhythms have been reported in studies of both depressed children and of depressed adolescents. The aim of this study was to evaluate whether there is a relationship between the 24-hour spectral power (24h SP) of the activity/rest rhythm and the clinical course of depression in adolescents. Six 14 to 17-year-old adolescents were recruited for the study. They were all suffering from major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, as identified by the Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version (K-SADS-PL). Depressive symptoms were assessed using the Children's Depression Rating Scale - Revised (CDRS-R) and clinical evaluations. Locomotor activity was monitored over a period of 13 consecutive weeks. Activity was measured for 10-minute periods using wrist-worn activity monitors. All patients were prescribed sertraline from after the first week up until the end of the study. We found a relationship between high CDRS values and low 24-hour spectral power. The 24h SP of the activity/rest rhythm correlated significantly (negatively) with the clinical ratings of depression.

Depression symptom trajectories and associated risk factors among adolescents in Chile.

Adolescence is a key period for studying the development of depression, with studies in Europe and North America showing a pattern of elevated risk that begins in early adolescence and continues to increase as adolescents age. Few studies have examined the course of adolescent depression and associated risk factors in low and middle-income countries. This longitudinal cohort study examined depression symptom trajectories and risk factors in a sample of socio-economically disadvantaged adolescents in Chile (n = 2,508). Data were collected over an 18-month period as part of a clinical trial for secondary students aged 12 to 18 (median age 14). Clinical levels of depression were prevalent in this sample at baseline (35% for girls and 28% for boys); yet latent growth models of symptom trajectories revealed a pattern of decreasing symptoms over time. There was evidence of an anxiety-depression developmental pathway for girls, with elevated anxiety levels initially predicting poorer depression outcomes later on. Poor problem-solving skills were associated with initial depression levels but did not predict the course of depressive symptoms. Critically, the declining symptom trajectories raise important methodological issues regarding the effects of repeated assessment in longitudinal studies.

FMRI Studies of Reward Processing in Adolescent Depression

Reward function is increasingly considered to be an important aspect of affective disorders such as depression and bipolar disorder. Conceptual models of affective disorders emphasize disrupted reward function as a neural characteristic of low positive affect in depression, and studies with adults have indicated that brain function in reward-related regions distinguishes those with depression from healthy controls. Based on an interest in adolescence, as both a vulnerable period for the onset of affective disorders and a period of ongoing development of neural reward circuitry, an emerging literature is now addressing reward-related brain function in adolescents with depression. Results have generally paralleled those from adult studies and have indicated value in studying reward function in relation to the etiology, pathophysiology, and treatment of depression in young people. Functional neuroimaging findings indicate that adolescents with depression (Forbes et al, 2009) and adolescents at risk for depression (eg, Gotlib et al, 2010) exhibit low striatal response to rewarding stimuli, such as money or happy facial expressions. This altered brain function has been observed during the anticipation of reward and the receipt of reward, suggesting that adolescent depression involves changes in both the motivation to obtain reward and the enjoyment of rewards once obtained. In addition, there is also some evidence that adolescents with depression exhibit more reactivity in prefrontal regions thought to have a role in regulating response to reward stimuli. Consistent with the findings of increased anterior cingulate response to reward in adults with depression, adolescents with depression exhibit less response in the medial prefrontal cortex (PFC) (Forbes et al, 2009), an area that is a key target, along with the striatum, of midbrain dopamine neurons. The medial PFC is a critical region in reward circuits, and its efferent connections include the ventral striatum (Haber and Knutson, 2010). The study of reward function has potential to elucidate many processes in the development and course of adolescent depression. Developmental findings that reward function changes with puberty and is associated with depressive symptoms in healthy adolescents (Forbes et al, 2010b) can inform the etiology of adolescent depression. Although the treatment implications of reward function research remain to be explored, initial findings suggest that adolescents' neural response to reward predicts symptom level and severity at outcome, as well as rate of symptom decrease during treatment for depression (Forbes et al, 2010a; Figure 1). This intriguing result represents one of the few biomarkers of antidepressant response in adolescent depression. Figure 1 In adolescents with major depressive disorder, (a) response to reward anticipation in the striatum (left) and medial prefrontal cortex (right) at treatment entry was related to (b) rate of reduction in anxiety symptoms during an 8-week treatment with ... Exciting new approaches to investigating reward function in adolescent depression include examining brain–behavior associations and employing personally relevant social stimuli. When combined with experience sampling, functional neuroimaging can identify regions of the striatum whose response distinguishes adolescents with depression from healthy adolescents and is also correlated with higher levels of positive affect experienced in natural environments (Forbes et al, 2009). Assessing neural response to social rewards, which are postulated to be critical for triggering adolescent depression (Davey et al, 2008), can provide a more meaningful understanding of altered reward function. In addition, future work will benefit from attention to clinical characteristics such as anhedonia, comorbid anxiety and clinical course.

Overgeneral autobiographical memory and chronic interpersonal stress as predictors of the course of depression in adolescents

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of depression in adolescents. As part of a larger longitudinal study of risk for emotional disorders, 55 adolescents with a past history of major depressive disorder or minor depressive disorder completed the Autobiographical Memory Test. Fewer specific memories predicted the subsequent onset of a major depressive episode (MDE) over a 16-month follow-up period, even when covarying baseline depressive symptoms. This main effect was qualified by an interaction between specific memories and chronic interpersonal stress: Fewer specific memories predicted greater risk of MDE onset over follow-up at high (but not low) levels of chronic interpersonal stress. Thus, our findings suggest that OGM, in interaction with chronic interpersonal stress, predicts the course of depression among adolescents, and highlight the importance of measuring interpersonal stress in OGM research.

Longitudinal Course of Adolescent Depression: Neuroendocrine and Psychosocial Predictors

The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support. Fifty-five adolescents with depression (age range 13-18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment. Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence. These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.

Longitudinal Course of Adolescent Depression: Neuroendocrine and Psychosocial Predictors

<h3>Objective</h3> The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support. <h3>Method</h3> Fifty-five adolescents with depression (age range 13–18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment. <h3>Results</h3> Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence. <h3>Conclusions</h3> These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.

Brief Report: Excessive alcohol use negatively affects the course of adolescent depression: One year naturalistic follow-up study

The impact of alcohol use on the course of adolescent depression over one-year was investigated by following 197 consecutive adolescent outpatients with unipolar depression in a naturalistic treatment setting. Their baseline alcohol consumption was categorized in three groups: excessive use (defined as weekly drunkenness), regular use (monthly use, not weekly drunkenness), and no/occasional use (abstinence/less than monthly use). During the monthly BDI follow-up, the excessive users achieved remission less frequently, and after one year, had poorer psychosocial functioning than the no/occasional users. In conclusion, excessive alcohol use negatively affects the course of adolescent depression and psychosocial functioning. Weekly drunkenness seems to be of predictive value and this can be examined with a few simple questions. Means of reducing alcohol consumption among depressed adolescents are worth further investigations.

Predicting onset and course of adolescent depression with sleep and cortisol measures

Predicting onset and course of adolescent depression with sleep and cortisol measures