Youth Depressive Symptoms Research Articles

Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset.

Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

Dynamics of Positive Emotion Regulation: Associations with Youth Depressive Symptoms

Depression is frequently considered a disorder of impaired affect regulation with deficits across both positive and negative affective systems. However, where deficits in emotion regulation occur in youth, specifically regarding regulation of positive emotions, is relatively unknown. The current study tested whether deficits in broad (felt and expressed) and specific (up-regulation and maintenance) positive emotion processes are associated with youth depressive symptoms. Adolescents (n = 134; 65 girls) in grades 7 to 9 completed a self-report measure of depressive symptoms prior to participating in two parent-child interactions tasks, a rewarding trivia task and a problem-solving conflict task. During the interaction tasks, adolescent's overall self-reported experience and observed expression of positive affect (PA) was examined. Following the reward task, youth's ability to up-regulate PA (PA response) and maintain PA while buffering against NA (PA persistence) was explored observationally. Results suggested that reduced experience and expression of PA was associated with depression symptoms, but only in a context that elicited negative emotions. No association was found between PA response and depression symptoms; however, shorter PA persistence was associated with elevated depressive symptoms. Youth higher in depressive symptoms appear able to respond similarly to rewarding events, but fail to maintain PA and ward off NA when transitioning from a positive to negative task.

Dwelling on it may make it worse: the links between relational victimization, relational aggression, rumination, and depressive symptoms in adolescents.

Although there is considerable evidence that relational victimization is associated with depressive symptoms in youth, our understanding about the mechanisms by which victimization and depressive symptoms are linked is limited. The current study explored ruminating about victimization experiences as a potential mechanism that might contribute to an understanding of the association between relational victimization and depressive symptoms. We also tested the specificity of the proposed models by controlling for and testing parallel models of a highly related behavior: relational aggression. A sample of 499 adolescents from sixth through eighth grades participated. Teacher reports were used to assess relational victimization and relational aggression. Self-reports were used to assess depressive symptoms and rumination. The results showed that rumination partially mediated the association between relational victimization and depressive symptoms. No moderation effect was found. In contrast, rumination moderated the association between relational aggression and depressive symptoms. Specifically, relational aggression was associated with depressive symptoms for those adolescents who were also ruminators. Thus, ruminating about victimization experiences appears to be an important mechanism that functions differently for relational aggression and relational victimization in conferring risk for depressive symptoms. The findings offer important practical implications for those working with adolescents and also lay the groundwork for future research.

Longitudinal relations between stress and depressive symptoms in youth: coping as a mediator.

The present prospective study examined the relations among stressful life events, coping, and depressive symptoms in children at varied risk for depression. Participants were 227 children between 7 and 17 years old (mean age = 12.13 years, SD = 2.31, 54.6 % female) who were part of a longitudinal study of depressed and nondepressed parents and their children. Youth completed measures assessing stressful life events and coping strategies at four time points over 22 months. Children's depressive symptoms were assessed at each time point by clinical interviews of parents and children, and children's self-report. Structural equation modeling indicated that stressful life events significantly predicted subsequent depressive symptoms. Bootstrap analyses of the indirect effects in three different models revealed that primary control engagement coping and disengagement coping strategies partially mediated the relation between stressful life events and children's depressive symptoms across time. Regarding the direction of effects, more consistent relations were found for coping as a mediator of the link from stress to depressive symptoms than from symptoms to stress. Thus, one potential mechanism by which stressful life events may contribute to depressive symptoms in children is through less use of primary control coping and greater use of disengagement coping strategies. This is consistent with the view that the adverse effects of stress may contribute to impairments in the ability to cope effectively.

Feasibility assessment of a brief, web-based behavioral activation intervention for adolescents with depressed mood.

Adolescent depression is a major public health concern. Efficacious interventions exist, but are underutilized. Novel approaches to improving access are therefore a top priority. Web-based approaches offer a viable treatment delivery solution; this approach may reach adolescents who might not otherwise receive formal treatment. Behavioral activation (BA) approaches have had success in treatment of depressive symptoms in youth. The purpose of this article is to: (1) describe the development process of a web-based, behavioral activation intervention for adolescents; (2) summarize the preliminary feasibility data; and (3) discuss the benefits and challenges associated with development and evaluation of adolescent self-help resources. The current study is part of a larger NIMH funded study focusing on the development and evaluation of Bounce Back Now (BBN), an evidence-informed, web resource for disaster-affected adolescents and their families. This study is specifically on the development of the BA component of the mood module of BBN, which was evaluated more extensively than other components. We present data from a formal usability evaluation conducted with 24 adolescents, and preliminary usage data collected from 2,000 disaster affected adolescents recruited from the tornado-affected coordinates in Alabama and Joplin, MO. Preliminary data supported the feasibility of this approach: qualitative data with the clinic-based sample revealed favorable reactions to the intervention, and preliminary data from the large ongoing randomized controlled trial have indicated moderate levels of access. Brief, web-based approaches may offer a promising alternative to address access barriers for adolescents with depressed mood.

Close Friends’ Psychopathology as a Pathway From Early Adversity to Young Adulthood Depressive Symptoms

Past research has highlighted the negative impact of early adverse experiences on childhood social functioning, including friendship selection, and later mental health. The current study explored the long-term effects of early adversity on young adults' close friends' psychological symptoms and the impact of these close friendships on later depressive symptoms. A prospective longitudinal design was used to examine 816 youth from a large community-based sample, who were followed from birth through age 25. Participants' mothers provided contemporaneous information about adversity exposure up to age 5, and participants completed questionnaires about their own depressive symptoms at age 20 and in their early 20s. Youth also nominated a best friend to complete questionnaires about his or her own psychopathology at age 20. Individuals who experienced more early adversity by age 5 had best friends with higher rates of psychopathology at age 20. Moreover, best friends' psychopathology predicted target youth depressive symptoms 2 to 5 years later. Results indicate that early adversity continues to affect social functioning throughout young adulthood and that best friendships marked by elevated psychopathology in turn negatively affect mental health. Findings have implications for clinical interventions designed to prevent the development of depressive symptoms in youth who have been exposed to early adversity.

Phenomenological considerations of family accommodation: Related clinical characteristics and family factors in pediatric obsessive–compulsive disorder

Family accommodation is a salient phenomenon within pediatric obsessive–compulsive disorder (OCD), with a large number of families engaging in behaviors and modifying family routines in response to the youth’s OCD symptoms. Family accommodation is commonly considered as a unidimensional construct, resulting in limited research on the phenomenological aspects of family accommodation and how different facets (i.e., participation, modification, and distress/consequences) may impact pediatric OCD. As such, the present study sought to examine the extent to which family accommodation, as a whole and within subtypes, was related to OCD symptom severity and symptom dimensions, youth clinical characteristics (i.e., internalizing/externalizing symptoms, depressive symptoms), and family factors (i.e., cohesion and conflict). Family accommodation was related to OCD symptom severity and the contamination symptom dimension, youth depressive symptoms (but not the participation domain), and youth internalizing/externalizing symptoms. Youth externalizing symptoms mediated the relationship between OCD symptom severity and family accommodation. After controlling for OCD symptom severity, youth externalizing symptoms predicted family accommodation in general, as well as the distress/consequences domain. Family cohesion predicted participation in OCD symptoms, above and beyond OCD symptom severity. Detailed results and implications of the findings are discussed.

Early Socioeconomic Adversity and Young Adult Physical Illness: The Role of Body Mass Index and Depressive Symptoms

PurposeThe present study investigated the psychophysiological inter- and intra-individual processes that mediate the linkage between childhood and/or adolescent socioeconomic adversities and adult health outcomes. Specifically, the proposed model examined the roles of youth depressive symptoms and body mass index (BMI) trajectories as mediators that explain the link between early adversity and young adults' general health and physical illnesses after controlling for gender, race or ethnicity, and earlier general health reports. MethodsUsing a nationally representative sample of 12,424 from National Longitudinal Study of Adolescent Health (Add Health), this study used growth curve modeling to consider both the severity (initial level) and the change over time (deterioration or elevation) as psychophysiological mediators, thereby acknowledging multiple facets of depressive symptoms and BMI trajectories as psychophysiological mediators of early adversity to adult health. ResultsResults provide evidence for (1) the influence of early childhood and early adolescent cumulative socioeconomic adversity on both the initial levels and changes over time of depressive symptoms and BMI and (2) the independent influences depressive symptoms and BMI trajectories on the general health and the physical illnesses of young adults. ConclusionsThese findings contribute valuable knowledge to existing research by elucidating how early adversity exerts an enduring long-term influence on physical health problems in young adulthood; furthermore, this information suggests that effective intervention and prevention programs should incorporate multiple facets (severity and change over time) of multiple mechanisms (psychological and physiological).

Depressive Symptoms in Youth with Inflammatory Bowel Disease Compared with a Community Sample

Previous investigations have produced mixed findings on whether youth with inflammatory bowel disease (IBD) experience elevated rates of depressive symptoms. Our first aim was to compare self-report of depressive symptoms by youth with IBD with a community sample. The second aim was to examine the relationship between symptoms of depression and measures of disease activity. Item-level responses on the Children's Depression Inventory among a sample of 78 youth diagnosed with IBD were compared with responses from a community sample using 1-sample t-tests. Particular attention was given to items assessing somatic symptoms of depression given the potential overlap with IBD disease symptoms. The relationship between depressive symptoms and IBD disease activity was evaluated using Spearman's rank correlation coefficients and linear regression. Youth with IBD reported lower levels of depressive symptoms compared with the community sample on the Children's Depression Inventory Total Score, and similar or lower levels of difficulty on items assessing somatic symptoms. Most of the sample had inactive or mild disease activity at the time of participation, with 14% experiencing moderate/severe disease activity. Higher ratings of disease activity were related to greater depressive symptoms. Responses on somatic items from the Children's Depression Inventory were not differentially related to disease activity. As a group, pediatric patients with IBD did not experience the clinical levels of depressive symptoms or elevations in depressive symptoms when compared with a community sample. Somatic symptoms of depression do not differentiate youth with IBD experiencing elevations in disease activity from youth experiencing nonsomatic symptoms of depression.

Parental anxiety as a predictor of medication and CBT response for anxious youth.

The aim of this investigation was to evaluate how parental anxiety predicted change in pediatric anxiety symptoms across four different interventions: cognitive-behavioral therapy, medication (sertraline; SRT), their combination (COMB), and pill placebo. Participants were 488 youths (ages 7-17) with separation anxiety disorder, generalized anxiety disorder, and/or social phobia and their primary caregivers. Latent growth curve modeling assessed how pre-treatment parental trait anxiety symptoms predicted trajectories of youth anxiety symptom change across 12 weeks of treatment at four time points. Interactions between parental anxiety and treatment condition were tested. Parental anxiety was not associated with youth's pre-treatment anxiety symptom severity. Controlling for parental trait anxiety, youth depressive symptoms, and youth age, youths who received COMB benefitted most. Counter to expectations, parental anxiety influenced youth anxiety symptom trajectory only within the SRT condition, whereas parental anxiety was not significantly associated with youth anxiety trajectories in the other treatment conditions. Specifically, within the SRT condition, higher levels of parental anxiety predicted a faster and greater reduction in youth anxiety over the acute treatment period compared to youths in the SRT condition whose parents had lower anxiety levels. While all active treatments produced favorable outcomes, results provide insight regarding the treatment-specific influence of parental anxiety on the time course of symptom change.

Cross-ethnic measurement invariance of the SCARED and CES-D in a youth sample.

This study evaluated the cross-ethnic measurement invariance of 2 common screening measures of anxiety and depressive symptoms in youth. The measurement invariance of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) and the Center for Epidemiologic Studies Depression Scale (CES-D) was tested across 881 African American (Black; n = 396), Hispanic (n = 185), non-Hispanic White (White; n = 166), and Asian/Indian (n = 134) youth in the 7th grade. The measures were administered as part of a grade-wide screening to identify youth with elevated anxiety and depressive symptoms. The 5-factor model of the SCARED and the 4-factor model of the CES-D best represented the data for all ethnic groups. Results provided support for strong invariance of the SCARED across all 4 ethnic groups. Results provided support for strong invariance of the CES-D across Black, White, and Asian/Indian youth, and partial strong invariance for Hispanic youth. Overall, results suggest that factor means and total scores can be compared across groups. Factor mean differences across groups were identified for both measures. In particular, Hispanic youth reported greater levels of anxiety and depression in certain domains than White, Black, and Asian youth. Our findings support the use of the SCARED and CES-D as tools for measuring anxiety and depressive symptoms in ethnically diverse youth in the United States. Results are discussed with respect to the importance of establishing measurement invariance for screening measures of anxiety and depressive symptoms prior to comparing symptom levels across ethnic groups.

Oxytocin receptor gene polymorphism (rs53576) moderates the intergenerational transmission of depression

Maternal depression serves as a potent source of stress among offspring, greatly enhancing the risk of numerous adverse outcomes including youth depression. Several factors moderate the transmission of depression from mothers to offspring. However, the role of genetic characteristics in this process merits further exploration. Consistent with an interpersonal perspective on depression, the present study focused on a genetic polymorphism that has been shown to be relevant to social functioning, the rs53576 polymorphism of the oxytocin receptor gene (OXTR). In a community sample of 441 youth, OXTR genotype moderated the association between maternal depression in early childhood and youth depressive symptoms in adolescence, such that youth possessing at least one A allele of OXTR who also had a history of maternal depression exhibited the highest levels of depressive symptoms at age 15. In order to explore possible interpersonal mediators of this effect, conditional process analyses examined the role of youth social functioning in adolescence. Results suggest that OXTR genotype may partially account for the transmission of maternal depression to youth and support the role of dysfunctional social processes as a mechanism through which OXTR influences the development of depressive symptoms.

Race–Ethnicity and Culture in the Family and Youth Outcomes: Test of a Path Model with Korean American Youth and Parents

This study examined the interplay of parental racial-ethnic socialization and youth multidimensional cultural orientations to investigate how they indirectly and directly influence youth depressive symptoms and antisocial behaviors. Using data from the Korean American Families (KAF) Project (220 youths, 272 mothers, and 164 fathers, N = 656), this study tested the relationships concurrently, longitudinally, and accounting for earlier youth outcomes. The main findings include that racial-ethnic socialization is significantly associated with mainstream and ethnic cultural orientation among youth, which in turn influences depressive symptoms (but not antisocial behaviors). More specifically, parental racial-ethnic identity and pride discourage youth mainstream orientation, whereas cultural socialization in the family, as perceived by youth, increases ethnic orientation. These findings suggest a varying impact of racial-ethnic socialization on the multidimensional cultural orientations of youth. Korean language proficiency of youth was most notably predictive of a decrease in the number of depressive symptoms concurrently, longitudinally, and after controlling for previous levels of depressive symptoms. English language proficiency was also associated with a decrease in depressive symptoms, implying a benefit of bilingualism.

Depressive symptoms and observed eating in youth

Depressive symptoms in youth may be a risk factor for obesity, with altered eating behaviors as one possible mechanism. We tested whether depressive symptoms were associated with observed eating patterns expected to promote excessive weight gain in two separate samples. In Study 1, 228 non-treatment-seeking youth, ages 12–17y (15.3±1.4y; 54.7% female), self-reported depressive symptoms using the Beck Depression Inventory. Energy intake was measured as consumption from a 10,934-kcal buffet meal served at 11:00am after an overnight fast. In Study 2, 204 non-treatment-seeking youth, ages 8–17y (13.0±2.8y; 49.5% female), self-reported depressive symptoms using the Children’s Depression Inventory. Energy intake was measured as consumption from a 9835-kcal buffet meal served at 2:30pm after a standard breakfast. In Study 1, controlling for body composition and other relevant covariates, depressive symptoms were positively related to total energy intake in girls and boys. In Study 2, adjusting for the same covariates, depressive symptoms among girls only were positively associated with total energy intake. Youth high in depressive symptoms and dietary restraint consumed the most energy from sweets. In both studies, the effects of depressive symptoms on intake were small. Nevertheless, depressive symptoms were associated with significantly greater consumption of total energy and energy from sweet snack foods, which, over time, could be anticipated to promote excess weight gain.

Parent relationship quality buffers against the effect of peer stressors on depressive symptoms from middle childhood to adolescence.

During the transition to adolescence, several developmental trends converge to increase the importance of peer relationships, the likelihood of peer-related stressors, and the experience of depressive symptoms. Simultaneously, there are significant changes in parent-child relationships. The current study sought to evaluate whether positive relationship quality with parents continued to serve a protective effect by buffering the relationship between stressful life events, especially peer stress, and increases in depressive symptoms throughout the transition to adolescence. Participants in a large (N = 692) 2-site accelerated longitudinal study were recruited in 3rd, 6th, and 9th grade and followed every 3 months for 1 year. At baseline, parents and youth reported on parent-child relationship quality, and every 3 months thereafter reported on their levels of stressors and depressive symptoms. Parent relationship quality moderated the relationship of person-level fluctuations in peer stressors, such that there was a stronger association between peer stressors and increases in depressive symptoms in youth with lower levels of positive parental relationship quality. This effect was specific to peer stressors. These results suggest that low levels of parent relationship quality leave youth particularly vulnerable to the depressogenic effects of peer stressors from childhood through adolescence.

Depression symptoms among Mexican American youth: paternal parenting in the context of maternal parenting, economic stress, and youth gender.

Mexican American youth (N = 146; age range: 14-19 years) living in an immigrant enclave who resided with both parents reported depression symptoms, paternal and maternal acceptance, paternal and maternal harsh parenting, and economic stress. Despite lower levels of youth-reported paternal parenting relative to maternal parenting, paternal acceptance was significantly related to youth depression symptoms in a path model that accounted for parenting intercorrelations as well as other significant correlates of youth depression symptoms. We found evidence suggesting that the relation between youth-reported paternal acceptance and depression might be stronger for girls than for boys. Using an ecological analytic framework, we found that: (a) the link between economic stress and youth depression was robust, and (b) only one parenting variable (paternal acceptance) may partially mediate the link between economic stress and depression symptoms. Our results suggest that paternal parenting and youth gender deserve further consideration in longitudinal research and intervention research addressing depression among Latino youth. Ecological models that highlight the influence of settings where Latino youth and families live should be considered in research on the family relationship context of youth depression.

Genetic susceptibility to family environment: BDNF Val66met and 5-HTTLPR influence depressive symptoms.

Functional genetic polymorphisms associated with Brain-Derived Neurotrophic Factor (BDNF) and serotonin (5-HTTLPR) have demonstrated associations with depression in interaction with environmental stressors. In light of evidence for biological connections between BDNF and serotonin, it is prudent to consider genetic epistasis between variants in these genes in the development of depressive symptoms. The current study examined the effects of val66met, 5-HTTLPR, and family environment quality on youth depressive symptoms in adolescence and young adulthood in a longitudinal sample oversampled for maternal depression history. A differential susceptibility model was tested, comparing the effects of family environment on depression scores across different levels of a cumulative plasticity genotype, defined as presence of both, either, or neither plasticity alleles (defined here as val66met Met and 5-HTTLPR 'S'). Cumulative plasticity genotype interacted with family environment quality to predict depression among males and females at age 15. After age 15, however, the interaction of cumulative plasticity genotype and early family environment quality was only predictive of depression among females. Results supported a differential susceptibility model at age 15, such that plasticity allele presence was associated with more or less depressive symptoms depending on valence of the family environment, and a diathesis-stress model of gene-environment interaction after age 15. These findings, although preliminary because of the small sample size, support prior results indicating interactive effects of 5-HTTLPR, val66met, and environmental stress, and suggest that family environment may have a stronger influence on genetically susceptible women than men.

Reductions in depressive symptoms among substance-abusing runaway adolescents and their primary caretakers: A randomized clinical trial.

This study reports secondary outcome findings on depressive symptoms from a randomized clinical trial testing three interventions for substance-abusing runaway adolescents. In particular, the effect of a family systems therapy, Ecologically Based Family Therapy (EBFT), and two individual therapies, the Community Reinforcement Approach (CRA) and Motivational Enhancement Therapy (MET), on adolescent and primary caretaker (PC) depressive symptoms were compared. Findings showed that youth's depressive symptoms were significantly reduced in each treatment to 2 years postbaseline. However, the trajectory of change differed across treatments, with adolescents receiving MET showing a more rapid reduction in depressive symptoms but a quicker increase in symptoms compared with adolescents receiving EBFT. PCs receiving EBFT showed a statistically significant decline in depressive symptoms, but this was not observed for the CRA and MET conditions. These findings can be interpreted to favor EBFT, although future research is needed to test training and implementation strategies for family systems therapies in community-based runaway shelters.

Parenting behaviors and anxious self-talk in youth and parents.

The present study examined the association between parental anxious self-talk, parenting behaviors, and youth anxious self-talk. Parents and youth ages 7 to 14 (M = 10.17; N = 208; 53% male) seeking treatment for anxiety were evaluated for anxiety symptoms, youth anxious self-talk, parental anxious self-talk, and youth-perceived parenting behavior. Youth and parental anxious self-talk were assessed by both child and parent self-reports; youth-perceived parenting behaviors were assessed by youth-reports. Parenting behaviors included separate ratings of paternal and maternal (a) acceptance, (b) psychological control, and (c) firm/behavioral control. Correlational analyses revealed that maternal anxious self-talk, but not paternal anxious self-talk, was significantly associated with youth's anxious self-talk. Maternal anxious self-talk had an inverse association with youth-perceived maternal acceptance, but was not associated with youth-perceived maternal psychological or behavioral control. Higher youth-perceived maternal acceptance was significantly associated with lower youth anxious self-talk. Youth-perceived maternal acceptance partially mediated the association between mother's anxious self-talk and youth's anxious self-talk. However, this mediation effect disappeared when taking into account youth depressive symptoms. Results are discussed in relation to clinical implications and future directions in research.

Stress generation in a developmental context: The role of youth depressive symptoms, maternal depression, the parent–child relationship, and family stress.

The present study examined stress generation in a developmental and family context among 171 mothers and their preadolescent children, ages 8-12 years, at baseline (Time 1) and 1-year follow-up (Time 2). In the current study, we examined the bidirectional relationship between children's depressive symptoms and dependent family stress. Results suggest that children's baseline level of depressive symptoms predicted the generation of dependent family stress 1 year later. However, baseline dependent family stress did not predict an increase in children's depressive symptoms 1 year later. In addition, we examined whether a larger context of both child chronic strain (indicated by academic, behavioral, and peer stress) and family factors, including socioeconomic status and parent-child relationship quality, would influence the stress generation process. Although both chronic strain and socioeconomic status were not associated with dependent family stress at Time 2, poorer parent-child relationship quality significantly predicted greater dependent family stress at Time 2. Child chronic strain, but neither socioeconomic status nor parent-child relationship quality, predicted children's depression symptoms at Time 2. Finally, gender, maternal depression history, and current maternal depressive symptoms did not moderate the relationship between level of dependent family stress and depressive symptoms. Overall, findings provide partial support for a developmental stress generation model operating in the preadolescent period.