Elevated Depressive Symptoms Research Articles

The role of labor market inequalities in explaining the gender gap in depression risk among older US adults

We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for older US women compared to men. We analyze data from 35,699 US adults aged 50–80 years that participated in the Health and Retirement Study. The gender gap is calculated as the difference in prevalence in elevated depressive symptoms (score ≥ 3 on the 8-item Center for Epidemiological Studies Depression Scale) between women and men. We employ a dynamic causal decomposition and simulate the life course of a synthetic cohort from ages 50–80 with the longitudinal g-formula and introduce four nested interventions by assigning women the same probabilities of A) being in an employment category, B) occupation class, C) current income and D) prior income group as men, conditional on women's health and family status until age 70. The gender gap in depression risk is 2.9%-points at ages 50–51 which increases to 7.6%-points at ages 70–71. Intervention A decreases the gender gap over ages 50–71 by 1.2%-points (95%CI for change: 2.81 to 0.4), intervention D by 1.64%-points (95%CI for change: 3.28 to −0.15) or 32% (95%CI: 1.39 to 62.83), and the effects of interventions B and C are in between those of A and D. The impact is particularly large for Hispanics and low educated groups. Gender inequalities at the labor market substantially explain the gender gap in depression risk in older US adults. Reducing these inequalities has the potential to narrow the gender gap in depression.

Longitudinal Examination of ENDS Use Among Young Adult College Students: Associations with Depressive Symptoms and Sensation Seeking.

The present study examined (1) intraindividual changes in the frequency of electronic nicotine delivery systems (ENDS) use across young adulthood, 18 to 30years old, and (2) if depressive symptoms and sensation-seeking tendencies, independently and in interaction with one another, were associated with these changes. Data were from a longitudinal study of students recruited from 24 Texas colleges and followed across six waves from fall 2015 to spring 2019. Participants (n = 1298; 36.3% non-Hispanic white, 56.3% women) were 18 to 26years old in fall 2015 and all reported past 30-day ENDS use on at least one wave. We used growth curve modeling for an accelerated longitudinal design to examine if ENDS use frequency changed with increasing age and if depressive symptoms and sensation seeking, independently and in interaction with one another, were associated with these changes. Results showed that ENDS use frequency increased with increasing age. Depressive symptoms and sensation seeking were not independently associated with more frequent ENDS use or an accelerated increase in ENDS use frequency across increasing age. However, a significant two-way interaction indicated that young adults with elevated depressive symptoms used ENDS more frequently, but only when they had higher levels of sensation seeking. Findings indicate that young adults with depressive symptoms are a heterogeneous population and that those with high levels of sensation-seeking tendencies are at elevated risk for more frequent ENDS use. Interventions for young adults high in both sensation-seeking and depressive symptoms may help prevent and decrease ENDS use.

Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals.

Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.

Associations of DHEA(S) with negative and positive affect in people who smoke daily with elevated and low depression symptoms: A pilot laboratory study

Background: Individuals with depression symptoms have a harder time quitting smoking. High negative affect and low positive affect are core depression symptoms and arise following cigarette abstinence. Investigating associations of biological markers with negative and positive affect may provide valuable information about factors relevant to smoking cessation in individuals with elevated depression symptoms. Methods: Depression symptoms were measured at a baseline session. Participants then completed two counterbalanced experimental sessions (non-abstinent, abstinent) and completed measures of positive and negative affect, and provided saliva samples. Saliva samples were assayed at the Salimetrics’ SalivaLab (Carlsbad, CA) using the Salimetrics Salivary Dehydroepiandrosterone (DHEA) Assay Kit (Cat. No. 1-1202) and Dehydroepiandrosterone-sulfate (DHEA-S) Assay Kit (Cat. No. 1-1252). Results: There were no main or interactive associations of DHEA with negative affect. However, there were significant DHEAS × experimental session and DHEAS × experimental session × depression symptom level interactions with negative affect. In the high depression symptom group, DHEAS positively associated with negative affect during the non-abstinent experimental session, but DHEAS negatively associated with negative affect during the abstinent experimental session. There were no associations of DHEA or DHEAS with positive affect. Conclusion: This study found that DHEAS negatively associated with negative affect during cigarette abstinence in individuals with elevated depression symptoms. This is important as high negative affect during cigarette abstinence may result in a return to smoking.

An examination of the associations between depressive symptoms, perceived parental discipline, alcohol use, and drinking-related consequences during the first year of college: A moderated mediation model.

Depression is prevalent among adolescents and young adults and is associated with experiencing increased negative alcohol-related consequences; thus, it is imperative to identify malleable protective factors for alcohol risks in young adults experiencing elevated depressive symptoms. The current study longitudinally explored the effects of perceived parental alcohol-related discipline on the relationship between depressive symptoms, alcohol use, and negative drinking consequences during the transition into college. Incoming college students (N = 272, 63.2% female) completed web-based surveys before (July, T1) and after (October, T2) the transition into college and reported depressive symptoms, perceived alcohol-related discipline, alcohol use, and consequences of drinking experienced in the past 30 days. The moderated mediation model revealed that at above average perceptions of alcohol-related discipline, depressive symptoms were negatively associated with alcohol use, which in turn was associated with experiencing fewer negative consequences of drinking. The current study did not measure a diagnosis of major depressive disorder, and therefore our results may differ among clinical populations. In addition, we did not measure other parenting constructs shown to protect students with elevated levels of depressive symptoms from experiencing consequences (i.e., monitoring). The present findings suggest perceptions of parental alcohol-related discipline measured here (e.g., having a privilege taken away, being scolded or grounded) can be protective against alcohol risks among college students experiencing above average depressive symptoms. Parent-based alcohol interventions administered prior to matriculation should encourage parents of depressed students to clearly communicate consequences for drinking to their child.

Abnormal neurophysiological sensitivity to rewards in depression is moderated by sex and age in middle adulthood

A candidate pathophysiological process in major depressive disorder is diminished neural reactivity to reward delivery, which is theorized to give rise to anhedonia. Reduced amplitude in the reward positivity (RewP), which captures initial reward evaluation, has been linked to current symptoms of depression among child, adolescent, and young adult samples. However, the developmental trajectory of this association is incomplete, with relatively few studies in middle and older adulthood. Further, emerging evidence in the literature also suggests that this association may be linked to female sex-specific processes, but no studies to date have directly contrasted the effect of sex on the depression-RewP association. The current study sought to address these gaps by testing how sex and age may moderate the depression-RewP association within a mature adult community sample. Symptoms of depression were evaluated using a survey and a clinical interview, and the RewP was elicited using a simple guessing task. There was a three-way interaction between depression symptom severity, age, and sex in predicting RewP amplitude. This was driven by younger (late 30’s to early 40’s) female-sexed people such that for this group, elevated symptoms of depression were associated with blunting of the RewP. This association tapered around age 50. This effect was specific to clinician-rated rather than self-reported depressive symptom severity. This pattern of effects suggests that among female-sexed people, developmental processes continue to shape the association between reward responsiveness and depression throughout middle adulthood.

Effects of resistance exercise training on depressive symptoms among young adults: A randomized controlled trial

Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are limited. This randomized controlled trial examined the effects of eight weeks of ecologically-valid, guidelines-based RET, compared to a wait-list control, on depressive symptoms among 55 young adults (26±5y; 36 female) with and without subclinical, or analogue, Generalized Anxiety Disorder (AGAD; Psychiatric Diagnostic Screening Questionnaire GAD subscale ≥6 and Penn State Worry Questionnaire ≥45) and Major Depressive Disorder (AMDD). Following a three-week familiarization period, participants completed one-on-one, twice-weekly RET sessions. The 16-item, self-reported Quick Inventory of Depressive Symptomatology (QIDS) assessed depressive symptoms. RM-ANCOVAs examined between-group differences, and significant interactions were decomposed with simple effects analysis. Hedges’ d effect sizes (95%CI) quantified the magnitude of differences in change between groups across time. Stratified analyses were conducted among subsamples with AMDD and AGAD. There were no baseline depressive symptom differences between groups. Attendance was 83%, and compliance was 80%. RET induced statistically significant, clinically-meaningful, large-magnitude reductions in depressive symptoms from baseline to week eight in the total (d = 1.01; [95%CI: 0.44–1.57]), AMDD (d = 1.71; [95%CI: 0.96–2.46]), and AGAD (d = 1.39; [95%CI: 0.55–2.24]) samples. These findings support guidelines-based RET as a promising treatment for mild depression.

Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial

BackgroundAlthough many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available.MethodsThis study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status.ResultsMost women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48–0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status.ConclusionsLocal government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings.Trial registrationUMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

Posttraumatic stress symptoms in adolescents and young adults with a chronic somatic disease: a mixed-methods study

BackgroundAdolescents and young adults (AYA) with a chronic somatic disease (CD) have a 3-fold higher risk of post-traumatic stress disorder (PTSD) than healthy controls. In addition, elevated post-traumatic stress symptoms (PTSS) have a negative impact on CD severity, treatment adherence, health problems and functional impairment. However, a more detailed understanding of this comorbidity is lacking.MethodsAYA with type 1 diabetes mellitus, juvenile idiopathic arthritis or cystic fibrosis (12–21 years of age) and elevated anxiety and/or depression symptoms, as well as their reference persons (≥ 18 years of age), completed online questionnaires in self- or observer report. The most stressful event related to the CD was reported descriptively. Questionnaires were used to assess PTSS, anxious and depressive symptoms, actual overall health, coping, personal growth and social support. Qualitative content analysis, linear regression models and correlations were used for mixed methods analysis.ResultsAccording to the reports of n = 235 AYA (mean age 15.61; 73% girls) and n = 70 reference persons, four categories were identified as the most stressful events due to CD: (1) psychological burden (40% of AYA / 50% of reference persons); (2) CD self-management (32% / 43%); (3) social burden (30% / 27%); and (4) physical impairment (23% / 16%). 37% of AYA reported clinically relevant PTSS due to CD. The best predictors of PTSS severity were anxious-depressive symptoms, emotional coping, personal growth and current overall health (F(4, 224) = 59.404, R² = 0.515, p < .001). Of all categories, psychological (β = 0.216, p = .002) and social burden (β = 0.143, p = .031) showed significant association with the severity of PTSS (F(4, 230) = 4.489, R² = 0.072, p = .002). The more categories the most stressful event addressed, the higher was the PTSS symptom severity (r = .168, p = .010).ConclusionsMany AYA showed clinically relevant PTSS and reported experiencing stressful events in several areas of life through their CD. The association between the stressful event categories and other variables could help identify AYA with CD who need psychological interventions the most.Trial registration: German Clinical Trials Register (DRKS): DRKS00016714, registered on 25/03/2019 and DRKS00017161, registered on 17/09/201.

1795-PUB: Teaming Up for T1D with Telehealth—An Initial Look at Youth and Family Coping following a New T1D Diagnosis

Purpose: A diagnosis of T1D is often associated with increased youth and parental distress as families learn to manage complex daily diabetes tasks and navigate glycemic fluctuations. This study sought to capture the early experiences of families following initial diagnosis, specifically focusing on its psychosocial impact. Method: Eight children (8-12; M=9.0; SD=1.3), 12 teenagers (13-17; M=14.7; SD=1.9) with T1D and 31 parents of youth ages 3-17 diagnosed with T1D were surveyed two weeks following diagnosis as part of a larger pilot of a prevention intervention to support families during the first-year post diagnosis. Additionally, electronic medical records were reviewed 3 months post diagnosis to evaluate health care utilization and medical outcomes. Results: Two weeks post T1D diagnosis, some parents (38.7%) and youth (18.8%) reported elevated symptoms of depression. Similarly, 36.7% of parents and 12.5% of youth reported elevated symptoms of anxiety. Fewer youth (11.8%) and parents (11.1%) endorsed elevated diabetes distress at two weeks post-diagnosis. At 3 months, mean A1c was 7.5% (SD = 1.4) and mean time in range was 67% (SD = 21.8). No baseline variables were correlated with A1c at 3 months post-diagnosis; however, youth report of family conflict was negatively correlated with time in range (r = -.761; p &amp;lt;.01). At 3 months following diagnosis, nearly all (92.6%) youth were using CGM, while few (7.7%) were using insulin pumps. Discussion: This study examined the experiences of youth and their parents following a T1D diagnosis, along with 3-month post diagnosis clinical outcomes. Many parents experience elevated symptoms of depression and anxiety two weeks following diagnosis. Few baseline variables correlated with clinical outcomes at three months following diagnosis. Future studies should examine family experiences in the first year following diagnosis, as well as interventions that promote positive coping among youth and their parents. Disclosure K.R.Howard: Stock/Shareholder; Abbott, AbbVie Inc. N.W.Smith: None. K.P.Garza: None. J.Weissberg-benchell: Advisory Panel; Beta Bionics, Inc., Research Support; Beta Bionics, Inc. M.Feldman: None. Funding JDRF (2-SRA-2020-985-S-B)

Do fatigue and depression have a bivariate association with device-measured physical activity behavior in persons with multiple sclerosis?

Purpose This study examined the bivariate association between fatigue and depression symptoms and physical activity behavior in persons with multiple sclerosis (MS). Methods The sample of adults with MS completed the Fatigue Severity Scale (FSS) and the Hospital Anxiety and Depression Scale (HADS) and wore a waist mounted accelerometer during waking hours for 7 days. We categorized participants as having elevated fatigue and depression based on cut-points for the FSS (i.e., 4+ as indicative of severe fatigue) and the HADS (i.e., 8+ as indicative of elevated depressive symptoms). We used a two-way multivariate analysis of variance (MANOVA) to examine the contribution of fatigue and depression to volume and pattern of sedentary, light (LPA) and moderate-to-vigorous physical activity (MVPA). Results Results indicated no bivariate association between fatigue and depression and measures of physical activity behavior. The MANOVA indicated there was a significant association between fatigue and MVPA (F = 2.30, p = 0.032) and steps/day (F = 13.6, p < 0.001), independent of depression symptoms. There was no association between depression symptoms and physical activity behavior. Conclusions This study demonstrated an interrelation between fatigue symptoms and MVPA and steps/day in MS, independent of depression symptoms, and this should be considered in the future design and delivery of physical activity interventions in MS. IMPLICATIONS FOR REHABILIATION Fatigue and depression are prevalent and burdensome symptoms of multiple sclerosis (MS). These symptoms can collectively worsen psychological and functional outcomes in MS. Fatigue symptoms may impact ambulatory physical activity to a greater degree than depression symptom status in persons with MS. Fatigue is an important consideration when designing behavior change interventions targeted at promoting physical activity in persons with MS.

665-P: Longitudinal Impact of Daily Experienced Diabetes Distress and Affective Symptoms on the Incidence and Remission of Depressive Symptoms—Results of the DIA-LINK 1 and 2 Studies

We analyzed whether daily experience of diabetes distress and affective symptoms, assessed with ecological momentary assessment (EMA) can predict incidence or remission of elevated depressive symptoms in people with type 1 and type 2 diabetes. In the DIA-LINK studies, 203 people with type 1 and 193 people with type 2 diabetes participated. In the 17-day EMA phase, participants completed daily prompts assessing different affective symptoms and diabetes distress. 358 participants completed the CES-Depression questionnaire at baseline and 3 months later. Incidence and remission of elevated depressive symptoms were defined by a cut-off score of 22. Area under receiver operating characteristics curves were used to analyse the predictive performance of EMA variables on incidence and remission of depressive symptoms. Incidence of elevated depressive symptoms was 18.3% while 32.3% showed a remission. Predictive performances of 15 different EMA variables are shown in Table 1. Daily experience of diabetes distress and affective symptoms can predict incidence and remission of elevated depressive symptoms. These variables could be used for designing just-in-time adaptive interventions for preventing elevated depressive symptoms in people with diabetes experiencing daily emotional burden of living with diabetes. Disclosure D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. A.J.Schmitt: None. B.Olesen: Advisory Panel; AstraZeneca, Evivamed, Berlin-Chemie AG, Speaker's Bureau; Medtronic, Medtrixx. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. Funding German Center for Diabetes Research (FKZ82DZD1102A)

655-P: Diabetes Distress and Associated Factors among Low-Income Chinese Immigrants with Type 2 Diabetes

Purpose: To describe diabetes distress and its associated factors among Chinese immigrants with type 2 diabetes (T2D) in NYC. Methods: Cross-sectional data were derived from three research studies conducted among Chinese immigrants with T2D in NYC. Diabetes Distress Scale (DDS) was used to measure diabetes distress, which includes 4 subscales: emotional, regimen, interpersonal and physician-related distress. A total or subscale score ≥ 2 indicates a moderate or higher distress level and is considered clinically important. Patient Health Questionnaire-2 was used to measure depressive symptoms. Participants’ sociodemographic data were collected. Descriptive statistics and stepwise logistic regression were used. Results: Most participants (n=178) were currently married (76%), limited English proficient (93%), high school graduates or less (66%), and had an annual household income of less than $25K (62%). The mean age was 63.6 (SD=13.6) years old. About 26% of them reported moderate or higher overall distress levels. The most common sources of distress were emotional burden (30%), followed by regimen (29%), interpersonal (19%), and physician-related distress (14%). Participants who were younger, female, and had elevated depressive symptoms were more likely to have higher diabetes distress. Conclusions: Diabetes distress is prevalent in Chinese immigrants with T2D, especially emotional distress and regimen-related distress. Given the known negative impact of diabetes distress, it is critical to consider screening for diabetes distress and incorporating psychological counseling in diabetes care in this underserved population. Disclosure L.Hu: None. Y.Shi: None. C.Wang: None. H.Li: None. H.Bao: None. X.Xu: None. Y.Jiang: None. M.Sevick: None. N.Islam: None. Funding National Institutes of Health (R00MD012811, P30DK111022, U54MD000538-15)

675-P: Coparenting Cooperation and Conflict Predict Parent Depressive Symptoms 1.5 Years after Young Child T1D Diagnosis

Background: Managing T1D in a newly diagnosed young child significantly impacts family dynamics and is linked with elevated parental depressive symptoms. We examined the relationship among diabetes-related co-parenting cooperation and conflict soon after diagnosis with parent depressive symptoms 1 and 1.5 years later. Method: Participants were 157 primary caregivers (91.7% female, 76.4% married, 62.2% non-Hispanic White) of young children age 1-6 years (Mage=4.41.7 years; 54.8% female, 61.5% non-Hispanic White) in a behavioral intervention trial after child T1D diagnosis (M=29 days). Parents self-reported on Cooperation and Conflict subscales of the Diabetes-Specific Co-parenting Questionnaire (DCQ) and the Center for Epidemiological Studies Depression Scale (CES-D; ≥16=clinical elevation). Multiple logistic regressions were used with elevated depression score as outcome. Subjective socioeconomic status (SSES) and treatment condition were included as covariates. Results: Higher co-parenting conflict at baseline was associated with a 3.70 (OR=3.70, 95% CI=(1.68, 8.18) and 2.36 (OR=2.36, 95% CI=(1.13, 4.91)) higher odds of clinically elevated CES-D score risk at 1 and 1.5 years post-diagnosis, respectively. Higher co-parenting cooperation at baseline marginally reduced elevated CES-D odds by 0.58 (OR=0.58, 95% CI=(0.31, 1.10)) at 1.5 (but not 1) years post-diagnosis; higher SSES at baseline reduced depression odds by 0.97 (OR=0.97, 95% CI=(0.96, 1.00) at 1.5 (but not 1) years post-diagnosis. Discussion: Increased parental disagreements following T1D diagnosis may predict higher burden of managing T1D in a young child over time and possibly contribute to later depressive symptoms. Parental care strategies and interventions at T1D diagnosis that enhance supportive cooperation and communication among caregivers may help support parent psychosocial functioning over time. Disclosure L.Kang: None. C.H.Wang: None. M.E.Hilliard: None. C.Tully: None. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. Funding National Institutes of Health (1R01DK102561-01A1)

Adding web-based support to exercise referral schemes improves symptoms of depression in people with elevated depressive symptoms: A secondary analysis of the e-coachER randomised controlled trial

BackgroundExercise referral schemes (ERS) reduce depression but the additional effect on mental health from web-based behavioural support is unknown. The e-coachER trial reported no effect of augmenting usual ERS with theory-driven web-based behavioural support on moderate to vigorous physical activity (MVPA) at 12 months for patients with chronic physical and mental health conditions. The present study reports the effects of the e-coachER intervention on depression, anxiety and MVPA only among participants with elevated depressive symptoms and investigates whether these were mediated by changes in MVPA and hypothesised cognitive and behavioural processes. MethodsOf the original 450 adults recruited into the e-coachER trial, 205 had at least mild depression, based on the Hospital Anxiety and Depression Scale (HADS), and were included in the present analysis. Data collected included the HADS, accelerometer measured and self-reported MVPA and survey process measures on physical activity action planning, self-monitoring and goal reviewing, and perceived importance, confidence, competence, autonomy and support. Linear mixed models were used to compare groups for change in depression and anxiety at 4 and 12 months using intention-to-treat complete case analysis, controlling for baseline. We also examined whether changes in physical activity and process variables at 4 months mediated changes in depression and anxiety at 12 months. ResultsOf the 205 participants, 138 (67%) provided follow-up data at four months and 126 (61%) at 12 months. For those that provided follow-up data, those randomised to e-coachER reported improved levels of depression (−1.36, 95% CI: −2.55 to −0.18) but not anxiety, or MVPA, compared with controls at four months. No differences were observed at 12 months for depression, anxiety or MVPA. Intervention effects on accelerometer-measured or self-reported MVPA did not mediate improvements in depression or anxiety. However, intervention effects on confidence, competence and self-monitoring at four months significantly mediated the reduction in depression scores at four months. Intervention effects on competence and self-monitoring at four months also significantly mediated improvements in anxiety scores at four months. InterpretationAdding web-based support to usual ERS leads to reductions in depression but not anxiety at four months. Changes in depression and anxiety were influenced by changing people's motivational regulations toward physical activity. The benefit of adding web-based support to usual ERS on mental health appears to be from increasing a sense of confidence, competence and self-monitoring rather than from increasing physical activity in people with elevated depression. ERS should focus more on strengthening motivational regulations than just doing more exercise. Trial registrationISRCTN15644451.

Hyper- and hypocortisolism: Latent profiles of diurnal cortisol underlying depressive symptoms in adolescents

A secular trend of increased depressive symptoms among adolescents and early adults has received both scientific and media attention (Office of the Surgeon General, 2021). Research on cortisol and depression has revealed the important role of the HPA axis in internalizing disorders. But evidence remains mixed regarding the direction of effects, with findings of both higher and lower levels of diurnal cortisol associated with depressive symptoms. There is a need for new approaches to study the biological underpinnings of depressive symptoms. We analyzed diurnal cortisol among 141 adolescents (Mage = 15.0; 59.7% female; 50.8% white). Latent Profile Analysis (LPA) was used to characterize cortisol rhythms identified from four daily salivary samples (at waking, 30 minutes after waking, after school, and bedtime) taken over five days. Resulting profiles were examined in relation to reported stress, depressive symptoms, and other measures of psychosocial functioning. Analyses identified two cortisol profiles associated with elevated depressive symptoms. One had the lowest average cortisol levels at each sampling time throughout the day. The other corresponded to highly elevated diurnal cortisol, with both waking and bedtime levels exceeding 0.8 μg/dL. However, they diverged in associations with other aspects of psychosocial functioning. We will present the correlates of each diurnal profile and discuss implications for longitudinal work. Both elevated and suppressed cortisol rhythms were associated with higher depressive symptoms than those among adolescents with more typical rhythms. Using LPA to characterize diurnal cortisol may allow for better understanding of youth risk for depression.

Contexts of youth stress exposure: Implications for biological processes and internalizing problems in adolescence and early adulthood

Adolescence and early adulthood are recognized as times of rapid development, during which social experiences have heightened importance. These developmental stages also involve increased risk for psychopathology, including depression and other internalizing problems. This symposium aims to highlight how youth stress contexts, ranging from early life adversity to adult social relationships, can impact both biological processes and internalizing symptoms. The four papers in this symposium present data from diverse samples of US-based adolescents and young adults, using cross-sectional and prospective methods. Measures of biological functioning include neural sensitivity to reward, salivary sampling of diurnal cortisol, and DNA methylation. The first paper (Yang) finds that greater reward sensitivity is associated with reduced risk for internalizing symptoms—but that this beneficial association is not present for youth who live in high-conflict family environments. The second paper (Collier Villaume) identifies profiles of diurnal cortisol that are associated with depressive symptoms, finding evidence that both high and low diurnal rhythms are associated with elevated depressive symptoms, compared to those of adolescents with more typical diurnal rhythms. The third paper (Cook), which also examines diurnal cortisol, does so in relation to the social relationships of young sexual minority men. This work finds that race/ethnicity moderates associations between adult attachment and dysregulation of the cortisol awakening response. In the fourth paper (Koning), authors establish that early life adversity is associated with greater methylation of the stress-regulating SLC6A4 gene. Importantly, adversity experienced during adolescence is more strongly associated with DNA methylation than that reported during childhood. The overarching aim of this symposium is to better understand the varied contexts of stress that can affect biological processes and, in turn, young people’s internalizing problems. The panelists will discuss this work with attention to opportunities for minimizing harm or disrupting negative sequelae, in order to support the development and wellbeing of diverse adolescents and young adults.

“I’m always going to be tired”: a qualitative exploration of adolescents’ experiences of fatigue in depression

Adolescent depression is a prevalent and disabling condition, but current psychological treatments are only moderately effective. One way to enhance outcomes is to further our understanding of adolescent depression and improve our capacity to target the most frequently reported and problematic symptoms. A common but often neglected symptom of depression is fatigue, which is associated with considerable impairment and has the potential to interfere with adolescents’ engagement in psychological therapies. Despite this, the experience of fatigue in adolescent depression and how we target it in treatment is currently poorly understood. Therefore, we aimed to explore adolescents’ experiences and understandings of fatigue in depression, recruiting from clinical and community settings. Semi-structured interviews were conducted with 19 UK-based adolescents aged 14–18 years old with elevated symptoms of depression. Using reflexive thematic analysis, three themes were generated. Fatigue is a complex concept explored adolescents’ understanding of fatigue as a dynamic, multifaceted symptom which had mental and physical components. Trapped in a cycle of fatigue considered the complex and reciprocal relationship between fatigue and other depressive symptoms, and the subsequent impact of limited energy on engagement with everyday activities. Finally, stigma as a barrier to help-seeking highlighted how adolescents were reluctant to seek help due to experienced stigma and the perception that fatigue was not a serious enough symptom. Findings from this study suggest that fatigue should be viewed as a psychological as well as somatic symptom of depression, with implications regarding the identification and treatment of fatigue in depression in routine clinical practice.

Social support and depression during a global crisis

Depression rates have risen globally during the COVID-19 pandemic. While social support is a known protective factor, more research is needed to quantify the extent to which social support could reduce depression risk during a global crisis and identify which types of support are most helpful and for whom. We analysed longitudinal data from 69,066 participants in the All of Us Research Program who completed COVID-19 Participant Experience surveys between May and July 2020, including measures of perceived social support and depressive symptoms. Using mixed-effects logistic regression models, we tested associations between social support (overall and its subtypes) and elevated depressive symptoms, and assessed potential effect modifiers. Approximately 16% of participants experienced elevated depressive symptoms. Overall social support was associated with a 55% lower odds of depression. Emotional/informational support and positive social interactions showed strongest protective associations with depression, followed by tangible support. Combinations of support subtypes showed a dose–response gradient, with higher levels across all three subtypes linked to over a sixfold reduction in depression odds. Significant effect modifiers included sex, age, pre-pandemic mood disorder and pandemic-related financial stressors. Enhanced social support across multiple domains could benefit individuals with higher risks for depression, supporting a precision prevention approach. Using data from a large US population survey, Choi et al. investigated the nuanced associations between perceived social support and the risk for depression during the COVID-19 pandemic.

The association between coping behaviors and the interpersonal theory of suicide in college students

High levels of stress are associated with suicide ideation among college students. The interpersonal theory of suicide provides a framework for conceptualizing the association between stress and suicide. This study will examine the associations between multiple types of stress (daily life hassles vs. negative life events) on suicidal ideation and the role of adaptive/maladaptive coping skills as potential moderators of the relationship between stress, thwarted belongingness, perceived burdensomeness, and suicidal ideation. The current study is a secondary analysis of data gathered from South-eastern university students in the U.S. College students (N = 218) with elevated depressive symptoms completed cross-sectional surveys. Participants were predominantly (78%) women and (72.8%) Hispanic, with a mean age of 20.81 years (SD = 3.96). Daily life hassles and negative life events were indirectly associated with suicidal ideation via perceived burdensomeness and thwarted belongingness. Only maladaptive coping behaviors significantly moderated the indirect effect of daily life hassles and negative life events on suicide ideation via perceived burdensomeness, but not thwarted belongingness. Thus, reliance on maladaptive coping behaviors increased the strength of the association between daily life hassles/negative life events and suicidal ideation. This study utilized cross-sectional data from a sample of college students with elevated depressive symptoms and may not generalize to other college student populations. Additionally, the use of cross-sectional data precludes causal interpretations of the findings. An improved understanding of potential buffers against the effects of stress can help identify opportunities for targeted prevention efforts to reduce rates of suicide-related behaviors in college students. Findings suggest that efforts to reduce student use of maladaptive coping behaviors may help to negate the negative impacts of stress on suicidal ideation.