Adolescent Depressive Disorder Research Articles

Cortical and subcortical gray matter alterations in first-episode drug-naïve adolescents with major depressive disorder.

Major depressive disorder is a major mental disorder affecting adolescents. Cortical thickness provides a sensitive measure of age-associated changes. Previous studies using cortical thickness analysis reported inconsistent results on brain structural changes in adolescent major depressive disorder. The neuroanatomical substrates of major depressive disorder in adolescents are not fully understood. We aimed to compare the anatomical structures of the brain in first-onset drug-naïve adolescents with major depressive disorder to normal controls. Twenty-seven first-episode drug-naïve adolescents with major depressive disorder and an equal number of age-matched control subjects were scanned on a 3T MRI scanner. Comparisons between those two groups were performed using surface-based morphometry analysis for cortical thickness and volumetric analysis of subcortical gray matter. The correlations between morphometric indexes and clinical measures (Hamilton depression rating scale score or children’s depression inventory score) were also calculated. We found that the cortical area is thinner in major depressive disorder patients than in controls, specifically in the left occipital area (precuneus and cuneus, cluster-level family-wise corrected P < 0.05). The hippocampus volume was also smaller in major depressive disorder patients than in the control group. No significant correlations were found between morphometric indexes (average cortical thickness extracted from the left precuneus cluster and hippocampal volume) and clinical measures. The left occipital cortical regions may have a role in the pathophysiology of adolescent major depressive disorder, and the involvement of the hippocampus is important for pathogenic changes even in the early stages of major depressive disorder.

Gender differences in trajectories of depressive symptoms across childhood and adolescence: A multi-group growth mixture model

BackgroundThis study sought to identify depression trajectories across childhood and to model a range of child and family predictors of whether a child may be on an increasing trajectory towards depressive disorder in adolescence. MethodsMulti-group growth mixture modelling (MGMM) was used on a sample of 4983 children from the Longitudinal Study of Australia Children (LSAC). Depressive symptoms of these children were assessed over 10-years with six time-points, administered every second year commencing at 4 years via the parent report version of the Strength and Difficulties Questionnaire. Predictors of class membership were also examined. ResultsFour trajectories were found to be the best fitting model characterising low-stable (75%); decreasing (11%); increasing (9%); high and rising (6%) groups. Females were more likely to be in a trajectory of increasing depressive symptoms between 4 and 14 years of age than males. Reactive temperament and maternal depression at four and six years of age were consistent predictors of increasing and high trajectories while persistent temperament acts as a protective factor for females. LimitationsThe findings should be interpreted in the light of limitations due to common-method variance and the absence of diagnostic indicators of depressive disorder. ConclusionsWe conclude that there are gender differences in patterns of depressive symptoms from childhood to adolescence and meaningful predictors of these early developmental trajectories. Preventative interventions in childhood targeting parents with depression and children with temperamental difficulties may be indicated.

Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives.

Epilepsy is associated with a significantly increased risk of developing depressive disorder during adolescence. On the other hand, depression is highly detected in adolescents with epilepsy. These findings highlight the importance of early identification and proper management of comorbid depression in adolescent age. The prevalence of depressive disorders in adolescents with epilepsy ranges between 8 and 35% and is higher than the general population of the same age. The relationship between epilepsy and depression is complex and potentially bidirectional, thereby suggesting a common underlying pathophysiology. Furthermore, failure to detect and treat depressive disorder mostly in adolescence could lead to several negative implications such as an increased risk of suicidal ideation or behavior and poor quality of life. A number of methods are available to detect depressive disorder, such as psychiatric or psychological assessments, structured or semi-structured interviews, and self-report screening tools. Thus, physicians should be able to regularly screen depressive symptoms in youths with epilepsy. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and has been validated in many countries. NDDI-E-Y has showed reliable validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care. The first step to be considered for the management of depressive disorder in adolescents with epilepsy is to consider potential reversible causes of anxiety and depression (i.e., a new AEDs; seizure control). Secondly, great attention has to be given to the education of the child/adolescent and his/her family, trying to improve knowledge about epilepsy as well as to decrease parental stress and improving the child’s sense of competence. Pharmacological treatment should also be considered in adolescents diagnosed with depression.

Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study

BackgroundDepression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood. MethodsThis study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16–17) and early adulthood (age 19–30). Healthcare usage and related costs in mid-adulthood (age 31–40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213). ResultsWomen with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care. LimitationsPrimary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion. ConclusionsOn a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

A systematic review of interventions for treatment resistant major depressive disorder in adolescents.

To update a comparative effectiveness review (1980-2011) of treatments for adolescents whose depressive episode or disorder (MDE/MDD) did not respond to one or more trials of SSRI antidepressants. MEDLINE, Cochrane Central, PsychINFO, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and AMED were searched in addition to the grey literature. We spanned May 2011 to September 1, 2017 and included only articles in English. 11 new studies were reviewed based on the criteria of having tested a comparative treatment in adolescents with MDD or MDE who were confirmed to have failed one or more SSRI trials. Data were extracted using standardized forms and a reference guide in DistillerSR; a second reviewer verified the accuracy of the data fields and discrepancies were resolved by consensus. One trial (N = 29) found a small benefit of escalating doses of fluoxetine and the treatment of adolescent depression study (TORDIA, N = 334) found significant benefits of combined SSRI or venlafaxine treatment with CBT for most outcomes. No new studies were identified since the previous review (2012). One trial is currently registered that will be a cross over trial of rTMS; other registered trials are open label. Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse. No new comparative studies were identified since the original review. Trials are desperately needed to identify new treatments for youth with SSRI resistant MDD. These youth should not be deemed as treatment resistant until completing one or two failed trials of SSRI combined with evidence-based psychotherapy.

Превентивное выявление депрессивных расстройств у подростков

Превентивное выявление депрессивных расстройств у подростков

Different Clinical Expression of Anxiety Disorders in Children and Adolescents: Assessment and Treatment.

Different Clinical Expression of Anxiety Disorders in Children and Adolescents: Assessment and Treatment.

Chronic Food Antigen-specific IgG-mediated Hypersensitivity Reaction as A Risk Factor for Adolescent Depressive Disorder

Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 μM) was significantly higher than that of the controls (9.73 μM, P < 0.001, Mann–Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood–brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.

Sleep-related breathing disturbances in adolescents with treatment resistant depression

Objective/backgroundA considerable subgroup of adolescents does not respond to standard antidepressant treatments. There are some indications that sleep disordered breathing may contribute to refractory depression in adults, but little is known about how it may relate to the course of depressive disorders in adolescents. Focussing on a group of Canadian adolescents with treatment resistant depression (TRD), this study aimed to investigate how the severity of residual depressive symptoms following unsuccessful antidepressant trials relates to breathing disturbances during sleep. Patients/methodsA retrospective chart review was conducted at a tertiary mental health facility. Polysomnography, the Beck Depression Inventory-II (BDI-II), and the Epworth Sleepiness Scale (ESS) were collated from 18 adolescents (15–18 years old, 44% females) patients with depressive disorders who did not respond to at least two 4-week trials of antidepressant medications. ResultsOf this sample, 39% reported at least mild levels of excessive daytime sleepiness, and 55% had an apnea/hypopnea index ≥1. Worse depressive symptoms correlated with higher RDI (r = 0.53, p = 0.022). This was mainly driven by respiratory effort-related arousals occurring during NREM sleep (r = 0.52, p = 0.029). No significant correlation was found between depressive symptoms and other respiratory or sleep variables. Higher daytime sleepiness correlated significantly with lower minimum oxygen desaturation (r = −0.51, p = 0.030). ConclusionsThese results suggest that even subtle respiratory disturbances during sleep may play a role in persistent depressive symptoms and treatment resistance. Early screening for sleep-related breathing disturbances in adolescents with TRD may be relevant, since previous work suggests that treating sleep-related breathing disturbances can attenuate depressive symptoms.

Psychometric Properties of the Patient Health Questionnaire-9 Modified for Major Depressive Disorder in Adolescents.

The Patient Health Questionnaire-9 Modified (PHQ-9M) is a self-report tool used to assess the presence and severity of depressive symptoms in teenagers. Despite widespread use in primary care clinics and psychiatric settings, the PHQ-9M has not been validated nor are its psychometric properties adequately understood for the adolescent population. This study sought to examine the psychometrics of the PHQ-9M in treatment-seeking, depressed adolescents at a psychiatric psychopharmacology clinic who were concurrently assessed with the Children's Depression Rating Scale Revised (CDRS-R) and Quick Inventory of Depressive Symptomatology-Adolescent (17-item) Self-Report (QIDS-A17-SR). Adolescents (N = 160) aged 13 through 18 years with a diagnosis of major depressive disorder, determined on the basis of a clinical interview and semi-structured interview using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, were assessed for severity of depressive symptoms with the PHQ-9M, CDRS-R (adolescent interview only), and QIDS-A17-SR assessments at baseline, 4, and 8 weeks. Classical test theory analysis was used to evaluate the internal consistency and dimensionality of the PHQ-9M. Convergent validity was evaluated via intraclass correlations of the PHQ-9M with the CDRS-R and QIDS-A17-SR. Sensitivity to treatment response was also evaluated. The internal consistency (Cronbach's coefficient α) at baseline, 4, and 8 weeks was 0.879, 0.859, and 0.827 for the PHQ-9M; 0.739, 0.835, and 0.867 for CDRS-R; and 0.712, 0.777, and 0.804 for QIDS-A17-SR, respectively. The PHQ-9M had moderate convergent validity with the CDRS-R but good convergent validity with the QIDS-A17-SR. The PHQ-9M was less sensitive to changes in symptom severity than the CDRS-R and QIDS-A17-SR. The PHQ-9M appears to be a valid and reliable assessment tool for the severity of depressive symptoms in a psychiatric clinic setting. However, its utility as a treatment outcome measure may be limited compared with other available rating scales.

Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies.

Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-V) criteria as in adults, borderline personality disorder (BPD) in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least five of the following domains: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation. BPD can be reliably diagnosed in adolescents as young as 11 years. The available epidemiological studies suggest that the prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% in adolescents consulting at an outpatient clinic to 78% in suicidal adolescents attending an emergency department. The diagnostic procedure is based on a clinical assessment with respect to developmental milestones and the interpersonal context. The key diagnostic criterion is the 1-year duration of symptoms. Standardized, clinician-rated instruments are available for guiding this assessment (eg, the Diagnostic Interview for Borderlines-Revised and the Childhood Interview for DSM-IV-TR BPD). The assessment should include an evaluation of the suicidal risk. Differential diagnosis is a particular challenge, given the high frequency of mixed presentations and comorbidities. With respect to clinical and epidemiological studies, externalizing disorders in childhood constitute a risk factor for developing BPD in early adolescence, whereas adolescent depressive disorders are predictive of BPD in adulthood. The treatment of adolescents with BPD requires commitment from the parents, a cohesive medical team, and a coherent treatment schedule. With regard to evidence-based medicine, psychopharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Supportive psychotherapy is the most commonly available first-line treatment. Randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy).

2.6 Persistent Depressive Disorder in Adolescence and Adult Functional Impairment: A Longitudinal Study of a Community-Based Cohort

2.6 Persistent Depressive Disorder in Adolescence and Adult Functional Impairment: A Longitudinal Study of a Community-Based Cohort

An Open Trial Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Prevention Program

Anxiety and depressive disorders in adolescents have an enormous burden worldwide due to their high prevalence and disability. Despite the high comorbidity between these disorders, preventive interventions have often been developed separately for anxiety and depression. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. in Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents, Oxford University Press, New York, 2018), a transdiagnostic treatment that targets core dysfunctions associated with anxiety and depression within a single protocol, was adapted as a universal preventive anxiety and depression program for the purposes of this investigation. The subsequent study of this adapted protocol evaluated pre- to post-intervention changes across a range of primary and secondary outcome measures. The secondary aims of this study were to assess the acceptability and feasibility of the adapted UP-A. Twenty-eight students (mean age = 14.67; SD = 0.87) participated in this uncontrolled trial conducted in Madrid, Spain. The program included nine weekly 55-min sessions administered in a school setting by an advanced doctoral student in clinical psychology to two groups of 15 and 13 students, respectively. Intent-to-treat analyses revealed significant declines in self-reported anxiety symptoms, interference of anxiety and depression, and top problems’ mean severity. Moderate to high participant satisfaction was indicated. The initial promising findings suggest that future trials of the UP-A adapted as a school-based universal anxiety and depression prevention program using a larger sample size are warranted. However, the results of this study should be interpreted cautiously due to limitations regarding the small sample size as well as the lack of a control group and a follow-up period. Suggestions are provided as to how the intervention might be refined in content and delivery.

Thai Adolescent Depression: Recurrence Prevention in Practice

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

Thai Adolescent Depression: Recurrence Prevention in Practice

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

The Impact of an Adolescent Depressive Disorders Clinical Pathway on Healthcare Utilization.

Clinical pathways are known to improve the value of health care in medical and surgical settings but have been rarely studied in the psychiatric setting. This study examined the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway and length of stay (LOS), cost, and readmissions. Patients in the high adherence category had significantly longer LOS and higher costs compared to the low adherence category. There was no difference in the odds of 30-day emergency department return visits or readmissions. Understanding which care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.

PHS6 - Racial/Ethnic Differences in the Treatment of Adolescent Major Depressive Disorders (MDD) Across Healthcare Providers Participating in the Medicaid Program

The objective of this research study was to examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. In this retrospective cohort study, adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005–2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. A general linear multi-level model (MLM) was used to examine whether being first identified by a psychiatrist is associated with higher treatment rate and reduced variation in treatment utilization across racial/ethnic groups. Of the 13,234-new pediatric MDD cases diagnosed during the study period, 61% were SWP-I, 33% by PSY-I and 6% by PCP-I. Results of the adjusted analysis showed that being first diagnosed by a psychiatrist is associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically regarding the receipt of pharmacotherapy, a significant interaction effect was detected between types of identifying providers and patients’ race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless receiving initial diagnosis from PCPs or PSYs, while for Hispanics, being first identified by a PCP is associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-I, reduced in SWP-I, and disappeared in PSY-I. For adolescents with MDD, being first diagnosed by a psychiatrist is associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.

Transcranial magnetic stimulation for the treatment of major depressive disorder in adolescents and young adults

Transcranial magnetic stimulation for the treatment of major depressive disorder in adolescents and young adults

Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the medicaid program

BackgroundTo examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. MethodAdolescents (10–20 years-old) with ≥2 MDD diagnoses were identified using 2005–2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. ResultsOf the 13,234-new pediatric MDD cases diagnosed, 61% were SWP-I, 33% PSY-I and 6% PCP-I. Results of the analysis using general linear multi-level model showed that being first diagnosed by a psychiatrist was associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4–0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1–0.2)). Specifically, regarding the receipt of pharmacotherapy, an interaction effect was detected between types of identifying providers and patients’ race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless being PCP-Is or PSY-Is, while for Hispanics, being first identified by a PCP was associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-Is, but not in PSY-Is. ConclusionFor adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.

Family meta‐emotion and the onset of major depressive disorder in adolescence: A prospective longitudinal study

AbstractMeta‐emotion philosophy refers to an organized set of thoughts, reactions, and feelings about one's emotions and the emotions of others (Gottman, Katz, &amp; Hooven, 1997). This study investigated the prospective relationship between family meta‐emotion processes and adolescent‐onset major depressive disorder (MDD). Adolescents (N = 198, mean age 12.5 years) and one of their parents each completed the Meta‐Emotion Interview (Katz &amp; Gottman, 1986), and adolescents were followed‐up at ages 15, 16.5, and 19 years to assess for MDD onset. In the Meta‐Emotion Interviews, parents and adolescents were asked about both their own, and the others', anger and sadness. Results showed that parent‐report of their own meta‐emotion philosophy of sadness prospectively predicted MDD onset in adolescence, as did adolescent‐report of low parental emotion coaching in relation to sadness, and adolescent self‐perceived emotional competence in relation to sadness. Adolescents' perceptions of family emotional environments characterized by high levels of parental anger expression and family conflict also prospectively predicted MDD onset. These findings highlight the continued importance of family emotional processes in adolescence, and provide insight into how parents' and adolescents' perceptions of emotional processes within the family, particularly in relation to sadness, may be prospectively associated with risk for adolescent onset MDD.