Risk Factor For Adolescent Depression Research Articles

Self-concept mediates the relationships between childhood traumatic experiences and adolescent depression in both clinical and community samples

BackgroundChildhood trauma is a pivotal risk factor for adolescent depression. While the association between childhood trauma and depression is well-established, the mediating role of self-concept has not been acknowledged. Specifically, limited attention has been paid to how childhood maltreatment impacts adolescent depression through physical and social self-concept, both in clinical and community samples. This study aims to investigate how distinct and cumulative childhood trauma affects adolescent depression, as well as the potential mediating role of self-concept in their relationships.MethodsWe recruited 227 depressed adolescents (dataset 1, 45 males, age = 15.34 ± 1.96) and 574 community adolescents (dataset 2, 107 males, age = 16.79 ± 0.65). Each participant was assessed on five subtypes of childhood trauma severity, cumulative trauma index, physical and social self-concept, and depression. Mediation models were tested separately in the clinical and community samples.ResultsClinically depressed adolescents experienced a higher level of trauma severity, a greater number of trauma subtypes, and had lower levels of physical and social self-concept compared to community adolescents. Analyses on childhood trauma severity and cumulative trauma index jointly indicated that physical and social self-concept played mediation roles in the relationships between childhood trauma experiences and depression. Moreover, the mediating effects of self-concept were stronger in depressed adolescents when compared to community samples.ConclusionsOur findings suggest that physical and social self-concept play mediating roles in the pathway linking childhood trauma and adolescent depression, particularly in clinically depressed individuals.

Explaining the Female Preponderance in Adolescent Depression—A Four-Wave Cohort Study

In the transition from childhood into adolescence, a female preponderance in depression emerges. Despite substantial empirical research to test theoretical propositions as to why this happens, our understanding is still limited. One explanation claims that girls become exposed to more stress (stress exposure model) whereas another proposes that girls become more vulnerable to the impact of stress (stress reactivity model) than boys when entering adolescence. Stressful life events (SLEs) and bullying victimization are established risk factors for adolescent depression. However, whether these factors contribute to the gender difference in depression is undetermined and thus investigated herein. Children (49.9% boys; n = 748) and parents from two birth cohorts in Trondheim, Norway, were followed biennially from ages 8 to 14 with clinical interviews about symptoms of depressive disorders and self-reports on SLEs. Teachers reported on bullying victimization. Prospective associations were investigated using an autoregressive latent trajectory model with structured residuals, examining within-person longitudinal associations while accounting for all time-invariant confounding effects. The number of depressive symptoms increased from ages 12 to 14 among girls. In the period before (ages 10 to 12), girls and boys were equally exposed to SLEs and bullying victimization. Increased stress (both SLEs and bullying victimization) at age 12 predicted increased depression at age 14 more strongly among girls than boys. Hence, increased impact—but not exposure—of SLEs and bullying victimization in girls may partly explain the emerging female preponderance in depression, in line with a stress reactivity model.

Depression in Adolescence and Brain-Derived Neurotrophic Factor.

The incidence of depression among adolescents has been rapidly increasing in recent years. Environmental and genetic factors have been identified as important risk factors for adolescent depression. However, the mechanisms underlying the development of adolescent depression that are triggered by these risk factors are not well understood. Clinical and preclinical studies have focused more on adult depression, and differences in depressive symptoms between adolescents and adults make it difficult to adequately diagnose and treat adolescent depression. Brain-derived neurotrophic factor (BDNF) is known to play a critical role in the pathophysiology of many psychiatric disorders, including depression. However, there are still few studies on adolescent depression. Therefore, in this review paper, the causes and treatment of adolescent depression and the function of BDNF are investigated.

Multi-level predictors of depression symptoms in the Adolescent Brain Cognitive Development (ABCD) study.

While identifying risk factors for adolescent depression is critical for early prevention and intervention, most studies have sought to understand the role of isolated factors rather than across a broad set of factors. Here, we sought to examine multi-level factors that maximize the prediction of depression symptoms in US children participating in the Adolescent Brain and Cognitive Development (ABCD) study. A total of 7,995 participants from ABCD (version 3.0 release) provided complete data at baseline and 1-year follow-up data. Depression symptoms were measured with the Child Behavior Checklist. Predictive features included child demographic, environmental, and structural and resting-state fMRI variables, parental depression history and demographic characteristics. We used linear (elastic net regression, EN) and non-linear (gradient-boosted trees, GBT) predictive models to identify which set of features maximized prediction of depression symptoms at baseline and, separately, at 1-year follow-up. Both linear and non-linear models achieved comparable results for predicting baseline (EN: MAE = 3.757; R2 = 0.156; GBT: MAE = 3.761; R2 = 0.147) and 1-year follow-up (EN: MAE = 4.255; R2 = 0.103; GBT: MAE = 4.262; R2 = 0.089) depression. Parental history of depression, greater family conflict, and shorter child sleep duration were among the top predictors of concurrent and future child depression symptoms across both models. Although resting-state fMRI features were relatively weaker predictors, functional connectivity of the caudate was consistently the strongest neural feature associated with depression symptoms at both timepoints. Consistent with prior research, parental mental health, family environment, and child sleep quality are important risk factors for youth depression. Functional connectivity of the caudate is a relatively weaker predictor of depression symptoms but may represent a biomarker for depression risk.

Dynamic risk for first onset of depressive disorders in adolescence: does change matter?

Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The 'Risk Escalation hypothesis' posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the 'Chronic Risk hypothesis' posits that the average level rather than change predicts first-onset DD. We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5-15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset. Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors. Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

1113Depressive symptoms and objectively measured physical activity and sedentary behaviour in adolescents

Abstract Background Physical activity and sedentary behaviour could be crucial risk factors for adolescent depression. This is the first study to use objective physical activity and sedentary behaviour measure to examine their association with depression in adolescents. Methods We analysed accelerometer data from population-based adolescents at ages 12, 14, and 16 and depressive symptoms at age 18. We used negative binomial regression and group-based trajectory models to analyse the data. Results We found that total physical activity decreased between 12 years and 16 years of age, driven by a decline in light activity and increase in sedentary behaviour. Each additional 60-minute increase in daily sedentary behaviour at ages 12, 14, and 16 was associated with an increased depression score at age 18 of 11·1% (95% CI, 5·1, 17·6), 8% (95% CI, 1·2, 15·2), and 10·5% (95% CI, 1·5, 20·8), respectively. Depression scores at age 18 were 9·6% (95% CI, 3·9, 15), 7.8% (95% CI, 0·8, 14.3), and 11·1% (95% CI, 2·6, 19.1) lower per additional 60-minutes of daily light activity time at ages 12, 14, and 16. These findings were robust to a series of sensitivity analyses. Conclusions Sedentary behaviour displaces light activity throughout adolescence and is associated with a higher risk of depressive symptoms at 18 years of age. Key messages Increasing light activity and decreasing sedentary behaviour during adolescence could be an important target for public health interventions aimed at reducing the prevalence of depression.

Prospective relationships of adolescents' screen-based sedentary behaviour with depressive symptoms: the Millennium Cohort Study.

Frequent use of screen-based devices could be a modifiable risk factor for adolescent depression, but findings have been inconsistent and mostly from cross-sectional studies. We examined prospective associations of video gaming, social media, and internet use with depressive symptoms in adolescents. A total of 11 341 adolescents from the Millennium Cohort Study, a representative, UK population-based. The main outcome was depressive symptoms from a Moods and Feelings Questionnaire (age 14). Exposures were frequency of video game, social media, and internet use (age 11). Physical activity (effect modifier) was measured by self-report. The fully adjusted models indicated that boys playing video games most days, at least once a week, and at least once a month at age 11 had lower depression scores at age 14 by 24.2% (IRR = 0.77, 95% CI 0.66-0.91), 25.1% (IRR = 0.75, 95% CI 0.62-0.90), and 31.2% (IRR = 0.69, 95% CI 0.57-0.83), compared with playing less than once a month/never. In girls, compared with less than once a month/never, using social media most days at age 11 was associated with 13% higher depression scores at age 14 (IRR = 1.13, 95% CI 1.05-1.22). We found some evidence of associations between using the internet most days and depressive symptoms compared with less than once a month/never in boys (IRR = 0.86, 95% CI 0.75-1.00). More frequent video game use was consistently associated with fewer depressive symptoms in boys with low physical activity, but not in those with high physical activity. Different types of screen-time may have contrasting associations with depressive symptoms during adolescence. Initiatives to address adolescents' screen-time may require targeted approaches.

Identifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study

BackgroundAdolescence represents a vulnerable period for the onset of depression. Globally, there is a need to better understand risk factors for adolescent depression to inform policies for effective prevention initiatives. MethodsA Delphi consensus study was conducted on risk factors, early signs, and detection strategies for adolescent depression in global settings. Over 3 survey rounds, global experts formulated and ranked these variables for (1) specificity for adolescent depression and (2) feasibility of measurement (round 1, n=21 participants; rounds 2 and 3, n=17). We calculated Smith's salience index as a measure of consensus. Interviews were conducted with 10 participants to elicit qualitative reflections on the ranking results, and on the influence of cultural and contextual factors on depression risks. ResultsThirty-one risk factors for adolescent depression were generated. Panelists ranked three as highly specific and highly feasible to measure: family history of depression, exposure to bullying, and a negative family environment. Six were ranked as modestly specific and highly feasible: physical illness or disability, female sex, bereavement, trauma exposure, substance abuse, and low self-esteem. An additional 5 items were modestly specific and modestly feasible: social difficulties, academic stress, poverty, loss of family, and cognitive distortions. Five symptoms were at least modestly specific and feasible to measure: mood changes, loss of interest, social isolation, suicidality, and sleep changes. Schools were considered the most feasible place for screening. LimitationsThe participants were not representative of all countries and cultural regions. ConclusionsThis study offers a profile of risk factors developed and prioritized by experts to inform a research agenda for risk, identification and prevention of adolescent depression across global settings.

Emotional Maltreatment and Adolescent Depression: Mediating Mechanisms and Demographic Considerations in a Child Welfare Sample.

Emotional maltreatment is a risk factor for adolescent depression. Yet, it remains unclear whether commissions and omissions of emotional maltreatment (a) confer vulnerability via distinct mechanisms and (b) demonstrate similar risk across adolescent subpopulations. The present, multiwave study examined whether school engagement and peer relationships explain the depressive effects of distinct emotional maltreatment subtypes in an at-risk child welfare sample (N=657; ages 11-14, AgeMean =12.49). The findings indicated that commission subtypes of emotional maltreatment predicted increasing depressive symptoms via increasing peer relationship problems, especially for girls. Meanwhile, decreasing school engagement was a depressogenic risk pathway for Hispanic adolescents reporting omission subtypes of emotional maltreatment. The results emphasize the importance of distinguish between emotional maltreatment subtypes to identify specific risk pathways for adolescent depression.

Sodium and potassium excretion predict increased depression in urban adolescents.

This study examined the prospective role of urinary sodium and potassium excretion in depressive symptoms among urban, low‐income adolescents, and whether these relationships vary by gender. A total of 84 urban adolescents (mean age 13.36 years; 50% male; 95% African American) self‐reported on their depressive symptoms at baseline and 1.5 years later. At baseline, the youth also completed a 12‐h (overnight) urine collection at home which was used to measure sodium and potassium excretion. After adjusting for baseline depressive symptoms, age, BMI percentile, and pubertal development, greater sodium excretion and lower potassium excretion predicted more severe depressive symptoms at follow‐up, with no significant gender differences. The results suggest that consumption of foods high in sodium and low in potassium contributes to the development of depressive symptoms in early adolescence, and that diet is a modifiable risk factor for adolescent depression. Interventions focusing on diet may improve mental health in urban adolescents.

Latent Profiles of Cognitive and Interpersonal Risk Factors for Adolescent Depression and Implications for Personalized Treatment.

A personalized approach to treatment with patients being matched to the best-fit treatment has been proposed as one possible solution to the currently modest treatment response rates for adolescent depression. Personalized treatment involves identifying and characterizing subgroups likely to respond differently to different treatments. We investigated the feasibility of this approach, by focusing on two key risk factors that are the purported treatment targets of cognitive behavioral therapy (CBT) and interpersonal psychotherapy for depressed adolescents (IPT-A): negative unrealistic cognitions and interpersonal relationship difficulties, respectively. We sought to learn whether subgroups high and low on the two risk factors, respectively, might be identified in a large sample of depressed, treatment-seeking adolescents. Latent class analysis (LCA) was conducted on measures of the two risk factors among 431 adolescents (age 12-17) in the Treatment for Adolescents with Depression Study. LCA identified three classes: (1) adolescents with high levels of problems in both family relationships and cognitions (21.6% of sample), (2) adolescents with moderate levels of problems in both domains (52.4%), and (3) adolescents with low levels of problems in both domains (26.0%). These subgroups did not predict treatment outcome with CBT or CBT + fluoxetine (COMB). The results challenge a current assumption about how treatments could be personalized, and they support a multi-causal model of depression rather than a risk-factor-specific model. Strategies other than risk factor-based personalizing for case assignment to CBT vs. IPT-A are discussed.

Adolescent Emotion Network Dynamics in Daily Life and Implications for Depression.

Emotion network density describes the degree of interdependence among emotion states across time. Higher density is theorized to reflect rigidity in emotion functioning and has been associated with depression in adult samples. This paper extended research on emotion networks to adolescents and examined associations between emotion network density and: 1) emotion regulation and 2) symptoms of depression. Data from a daily diary study (t = 21days) of adolescents (N = 151; 61.59% female; mean age = 14.60years) were used to construct emotion network density scores. Emotion regulation was measured using The Difficulties in Emotion Regulation Scale Short Form (DERS-SF). Depression was measured using the Revised Child Anxiety and Depression Scale-Short Version (RCADS-SV). Associations between emotion network density and DERS-SF were examined through Pearson correlations. Multiple regression analyses examined associations between emotion network density and depression. Emotion network density was not associated with the DERS-SF. Follow-up analyses showed that it was positively associated with non-acceptance of emotions (a subscale of the DERS-SF). Emotion network density was positively associated with RCADS-SV depression. Non-acceptance of emotions may encourage the spread of emotion across time and states given that a feature of non-acceptance is to have secondary emotional responses to one's emotions. Emotion networks that are self-predictive may be a risk factor for adolescent depression.

The association between paternal and adolescent depressive symptoms: evidence from two population-based cohorts

Incidence of depression increases markedly around age 13 years, and nearly three-quarters of adults report that their mental health problems started in adolescence. Although maternal depression is a risk factor for adolescent depression, evidence about the association between paternal and adolescent depression is inconclusive, and many studies have methodological limitations. We aimed to assess the association between paternal and adolescent depressive symptoms in two large population-based cohort studies. We used data for two-parent families from two representative prospective cohorts in Ireland (Growing up in Ireland [GUI]) and the UK (Millennium Cohort Study [MCS]). Parental depressive symptoms were measured with the Centre for Epidemiological Studies Depression Scale in the GUI cohort when children were 9 years old, and the Kessler six-item psychological distress scale in the MCS cohort when children were 7 years old. Adolescent depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) at age 13 years in the GUI cohort and age 14 years in the MCS cohort. We analysed data using linear regression models, before and after adjustment for confounders, in both multiply imputed and complete case samples. There were 6070 families in GUI and 7768 in MCS. After all adjustments, a 1 SD (three-point) increase in paternal depressive symptoms was associated with an increase of 0·24 SMFQ points (95% CI 0·03-0·45; p=0·023) in the GUI cohort and 0·18 SMFQ points (0·01-0·36; p=0·041) in the MCS cohort. This association was independent of, and not different in magnitude to, the association between maternal and adolescent depressive symptoms (Wald test p=0·435 in the GUI cohort and 0·470 in the MCS cohort). Our results show an association between depressive symptoms in fathers and depressive symptoms in their adolescent offspring. These findings support the involvement of fathers as well as mothers in early interventions to reduce the prevalence of adolescent depression, and highlight the importance of treating depression in both parents. Department of Children and Youth Affairs and Economic and Social Research Council.

Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences.

Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of "high-risk" individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their "low-risk" counterparts.

Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children

BackgroundChildhood trauma has been regarded as a risk factor for adolescent depression. Resilience has been found to be a protective factor for adolescent mental health. However, it is not clear about the role of resilience in the relationship between childhood trauma and depression. MethodsSchool attending adolescents (n=6406) aged 9–17 years were drawn from five primary schools, three middle schools and two high schools in Wuhan city of China in 2015. The participants were invited to complete self-report questionnaires, including demographics, childhood trauma, resilience and depressive symptoms. ResultsResilience played a partially mediating role in the relationship between childhood trauma and depressive symptoms. Resilience also moderated the association of childhood trauma with depressive symptoms. LimitationThe limitations of this study include cross-sectional study and self- reported instruments. ConclusionsWe conclude that resilience may play an important role in the relationship between childhood trauma and depressive symptoms. Our results suggest that enhancing resilience may provide new possibilities for prevention and intervention of depression in adolescents.

The ROOTS study: a 10-year review of findings on adolescent depression, and recommendations for future longitudinal research.

PurposeThe purpose of this study is to review longitudinal findings on adolescent mental health from the ‘ROOTS study’, and provide directions and recommendations for future longitudinal research. To do this, we discuss relevant findings from the ROOTS study, and review its strengths and limitations.MethodsWe examined all publications from the ROOTS study up to July 2015, selected those examining adolescent mental health, and classified them as investigating (a) childhood risk factors for adolescent depression, (b) genetic and cognitive vulnerability to depression in adolescence, (c) genetic markers, childhood adversities, and neuroendophenotypes, (d) morning cortisol and depression, (e) physical activity and depression symptoms, and (f) the underlying structure of mental health in adolescence. We reviewed the strengths and limitations of the ROOTS study, and how they feed into recommendations for future longitudinal research.ResultsThere was evidence supporting a putative hormonal biomarker for the emergence of depression in boys. Environmental pathways from child adversity to adolescent depression were confirmed in girls, partly accounted for by negative life events in early adolescence. The preceding role of automatic cognitive biases assessed using behavioural tasks was substantiated, with evidence for genetic susceptibility. Novel latent statistical models of child adversity, depression, anxiety, and psychotic experiences were produced, with concurrent and prospective validity. Our experiences conducting the ROOTS study resulted in a set of strengths, limitations, and recommendations for future longitudinal studies.ConclusionsThe ROOTS study has advanced knowledge on the aetiology of adolescent depression by investigating environmental, genetic, hormonal, and neural risk factors. Findings provide a foundation for future research integrating cognitive neuroscience with epidemiology.

Association between Weight Misperception Patterns and Depressive Symptoms in Korean Young Adolescents: National Cross-Sectional Study.

PurposeAlthough distortion of weight perceptions has been known as a risk factor for adolescent depression, little has been known about the relationship between weight misperception patterns and depressive symptoms. This study explored the relationship between distortion of weight misperception patterns and depressive symptoms in Korean adolescents.MethodsThe subjects of this study were 109,373 middle school students who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2011 to 2013. By comparing the difference between Body Mass Index (BMI) and subjective perceptions of body weight, misperceptions of weight were classified into two categories: misperception of underweight and misperception of overweight.ResultsWhen confounding variables were adjusted, the results of the logistic regression analysis revealed that male students who perceived themselves as underweight despite their normal weight were 110% more likely to have depressive symptoms (OR = 1.10, 95% CI: 1.03–1.18) than male students with accurate weight perceptions. On the contrary, for female students, misperceptions of underweight had no significant relationship with depression symptoms. Regarding misperceptions of overweight, female students who perceived themselves as overweight despite their normal weight were 107% (OR = 1.07, 95% CI: 1.02–1.11) more likely to have depressive symptoms than female students with accurate weight perceptions. Moreover, female students who perceived themselves as overweight when they were underweight were 137% (OR = 1.37, 95% CI: 1.18–1.58) more likely to have depressive symptoms.ConclusionMale students who underestimate their body weight and female students who overestimate their body weight were at a greater risk of depression emotions than students with accurate weight perceptions.

Interactive Effect of Child Maltreatment and Substance Use on Depressed Mood Among Adolescents Presenting to Community-Based Substance Use Treatment.

Adolescents referred to community behavioral health centers (CBHC) for substance use (SU) problems report high rates of child maltreatment. Although SU and maltreatment are independent risk factors for adolescent depression, few studies have examined their interactive effects. This study examined the interactive effects of SU (alcohol and marijuana) and exposure to different types of trauma on depressed mood among 74 adolescents referred to a CBHC for SU. Hierarchical regressions controlling for sex and common adolescent comorbidities showed that sexual abuse had a stronger relationship with depressed mood than other types of maltreatment. Although SU was not independently related to depressed mood, consistent with the self-medication hypothesis, increased SU was associated with lower levels of depressed mood among adolescents with greater exposure to sexual abuse. Results suggest that teens presenting to CBHCs for SU should be assessed for multiple forms of maltreatment and for depressed mood.

Maternal depressive symptoms during childhood and risky adolescent health behaviors.

Maternal depression is a risk factor for adolescent depression; however, the effect of childhood exposure to maternal depression on adolescent engagement in health risk behaviors (eg, substance use, delinquency) is unclear. We examined the relationship between maternal depressive symptoms (child's age 4-15) and engagement in health risk behaviors at age 16 to 17 by using data from 2910 mother-youth pairs in a nationally representative prospective Canadian cohort. Maternal depressive trajectories were estimated through finite mixture modeling, and multiple regression analyses examined the relationship between maternal depressive symptoms and engagement in various health risk behaviors (linear regression) and age of debut of various behaviors (Cox regression). Five trajectories of maternal depressive symptoms were found: recurrent maternal symptoms, midchildhood exposure to maternal symptoms, adolescent exposure to maternal symptoms, mild maternal symptoms, and low symptoms. Adolescents exposed to maternal depressive symptoms during middle childhood were more likely to use common substances (alcohol, cigarettes, marijuana), engage in violent and nonviolent delinquent behavior, and have an earlier debut ages of cigarette, alcohol, marijuana, and hallucinogen use. The results of this study suggest that exposure to maternal depressive symptoms, particularly in middle childhood, is associated with greater and earlier engagement in health risk behaviors.

Prevention strategies for adolescent depression

SummaryDepression is missed more often in adolescents than in adults, partly because they present with symptoms different from those in adults and because many do not seek help. Early detection or the delay of onset can have a significant effect on a young person's development and social functioning. We briefly discuss diagnosis and screening instruments before presenting the wide range of educational and psychological preventive approaches developed for adolescent depression. Many of the latter are based on the cognitive-behavioural or interpersonal therapy models. We consider how clinicians might use the current evidence base to identify and prevent depression in adolescents, and outline the principles of management of the disorder.LEARNING OBJECTIVES•Identify signs and symptoms of adolescent depression and recognise the difficulties in making a diagnosis.•Recognise the risk factors for adolescent depression.•Appreciate the aims and theoretical concepts of prevention strategies for adolescent depression.