Risk For Mood Disorders Research Articles

Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model.

Purpose/ObjectiveYoung people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population.MethodWe review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation.Results and ImplicationsWe present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.

Effects of e-cigarette use on mental health among youths: quasi-experimental evidence from Canada.

Existing research on mental health comorbidities of youth e-cigarette use is subject to confounding bias and reverse causality. This study aimed to measure the effects of e-cigarette use on youth mental health, using e-cigarette minimum legal age (MLA) law in Canada as a natural experiment. We used difference-in-differences (DD), difference-in-differences-in-differences (DDD) and two-sample instrumental variables (TSIV) methods. Data were from nationally representative Canadian Community Health Surveys 2008-2019 and Canadian Student Tobacco Alcohol and Drugs Surveys 2008-2019. The study sample comprised of respondents aged 15 to 18 (in DD analysis; n = 33 858) and aged 15 to 24 (in DDD analysis; n = 78 689). Primary outcomes were self-reported mood disorders and anxiety disorders. Secondary outcomes were cannabis use, illicit drug use, cigarette use and strength of peer relationships at schools. After the e-cigarette MLA laws, risks of mood disorders declined by 1.9 percentage points (95% CI, 0.0-3.8; P =0.05) in the DD analysis and by 2.6 percentage points (95% CI, 0.2-5.0; P =0.03) in the DDD analysis. For anxiety disorders, while the DD estimate was negative but imprecisely estimated, the MLA law reduced risks of anxiety disorder by 3.6 percentage points (95% CI, 0.9-6.2; P = 0.01) in the DDD analysis. Youths in provinces with MLA laws were also less likely to report cannabis use and illicit drug use and more likely to feel being part of schools. TSIV analysis indicates that youth e-cigarette use increased the likelihood of mood and anxiety disorders by 44% and 37%, respectively. In Canada, the e-cigarette minimum legal age law appears to have reduced risks of mood and anxiety disorders, lowered substance use and improved peer relationships at schools. Combined with previous evidence of lower e-cigarette use following the minimum legal age law, our findings indicate that youth e-cigarette use increases risks of mood and anxiety disorders.

P283. Developmental Trajectory of Body Weight in Offspring of Parents With Major Mood Disorders

People living with major mood disorders have high rates of metabolic and cardiovascular, leading to shorter life expectancy compared to people without mental disorders. Increased body weight predicts cardiometabolic issues and is highly prevalent in individuals with mood disorders, particularly women. It is unknown when in development this relationship begins. We aim to establish at what age weight increases in individuals with familial risk for mood disorders begins.

Anabolic-Androgenic Steroid Use is Associated with Major Depressive Disorder and Suicide Attempt: Analysis of a Multi-National Database

ABSTRACT Introduction Anabolic-androgenic steroids (AAS), synthetic derivatives of the male sex hormone testosterone, are often used to enhance athletic performance and physical appearance. Long term use of AAS can be associated with mood destabilizing effects and psychotic behavior. We hypothesized that AAS use is an independent risk factor for mental health disorders. We investigated AAS use and associations with major depressive disorder (MDD), suicide attempt (SA)/intentional self-harm (ISH), and body dysmorphic disorder (BDD) by querying TriNetX, a global health research network that provides data on large cohort of patients from multiple centers across the United States. Objective To determine the association between AAS use with MDD, SA/ISH, and BDD. Methods To evaluate the psychiatric risk of AAS use two cohorts of adult men, aged 18-50, without history of gender dysphoria (F64, Z87.890) (1) history of documented AAS use, inclusive of testosterone prescriptions (2) history of a visit to a healthcare organization and no history of AAS use. We accounted for confounding variables known to be associated with a risk of mood disorders through propensity score matching by logistic regression for age, race, ethnicity, male hypogonadism (E29.1), history of nicotine dependence (Z87.891), or alcohol-related disorder (F10). We evaluated the association between steroid use and subsequent diagnosis of MDD (F32-33), SA/ISH (T14.91, X71-83, T36-65 and T71 ISH codes), or BDD (F45.22) as a primary outcome through regression analysis with statistical significance assessed at p<.05. Results We identified 159,717 cis-men between age 18-50 who used AAS and following propensity score matching for confounding variables, we compared them to an equal-sized cohort of men without AAS use. AAS use was independently associated with all of the psychiatric outcomes that we studied (MDD OR 2.96 95% CI 2.88-3.04 p<.0001, SA/ISH OR 1.37 95% CI 1.25-1.50 p<.0001, BDD OR 5.37 95% CI 2.82-10.21 p<.0001). Strengths of the study include a large sample size, propensity score matching to adjust for confounding variables, and high strength of association. Limitations include lack of information regarding indication for steroid prescription or details regarding severity, duration, withdrawal, or possible steroid abuse. Conclusions AAS use appears to be an independent risk factor for MDD, BDD, and/or SA/ISH. Future studies are necessary to elucidate whether a dose-response association exists, withdrawal from AAS plays a role, and if patient selection or preventative measures can mitigate the risk. Men with suicide attempt, BDD, or MDD should be investigated for a history of AAS use. Further, men receiving AAS should be counseled on the possible risk of developing MDD in the future. AAS use can lead to profound and complex psychiatric complications which should be discussed in patient counseling. Disclosure No

Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity.

BackgroundAdolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration.MethodsBaseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity.ResultsOn school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights.ConclusionsOur findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.

Intrinsic Connectivity and Family Dynamics: Striatolimbic Markers of Risk and Resilience in Youth at Familial Risk for Mood Disorders

BackgroundFew studies to date have characterized functional connectivity (FC) within emotion and reward networks in relation to family dynamics in youth at high familial risk for bipolar disorder (HR-BD) and major depressive disorder (HR-MDD) relative to low-risk youth (LR). Such characterization may advance our understanding of the neural underpinnings of mood disorders and lead to more effective interventions. MethodsA total of 139 youth (43 HR-BD, 46 HR-MDD, and 50 LR) aged 12.9 ± 2.7 years were longitudinally followed for 4.5 ± 2.4 years. We characterized differences in striatolimbic FC that distinguished between HR-BD, HR-MDD, and LR and between resilience and conversion to psychopathology. We then examined whether risk status moderated FC–family dynamic associations. Finally, we examined whether baseline between-group FC differences predicted resilence versus conversion to psychopathology. ResultsHR-BD had greater amygdala–middle frontal gyrus and dorsal striatum–middle frontal gyrus FC relative to HR-MDD and LR, and HR-MDD had lower amygdala–fusiform gyrus and dorsal striatum–precentral gyrus FC relative to HR-BD and LR (voxel-level p < .001, cluster-level false discovery rate–corrected p < .05). Resilient youth had greater amygdala–orbitofrontal cortex and ventral striatum–dorsal anterior cingulate cortex FC relative to youth with conversion to psychopathology (voxel-level p < .001, cluster-level false discovery rate–corrected p < .05). Greater family rigidity was inversely associated with amygdala–fusiform gyrus FC across all groups (false discovery rate–corrected p = .017), with a moderating effect of bipolar risk status (HR-BD vs. HR-MDD p < .001; HR-BD vs. LR p = .005). Baseline FC differences did not predict resilence versus conversion to psychopathology. ConclusionsFindings represent neural signatures of risk and resilience in emotion and reward processing networks in youth at familial risk for mood disorders that may be targets for novel interventions tailored to the family context.

Prevalence of depressive symptoms and quality of life among patients with diabetes mellitus with and without HIV infection: A South African study.

BackgroundDiabetes mellitus (DM) and human immunodeficiency virus (HIV) infection are both associated with increased risk of mood disorders and poorer quality of life (QOL). This association has not been explored in patients living with comorbid DM and HIV.AimTo describe the prevalence of depressive symptoms and impact on the QOL in patients with DM living with and without HIV attending a public sector hospital in South Africa.SettingA medical outpatient clinic at a state regional hospital.MethodsA cross-sectional questionnaire pilot survey was conducted amongst 101 patients with DM attending a specialist medical outpatient service. The assessment was conducted using a structured socio-demographic and clinical questionnaire, the patient health questionnaire 9 (PHQ-9) for depressive symptoms and the World Health Organization QOL scale. The HIV status was confirmed from the clinical records. The correlates of depressive symptomatology in the participants with DM living with and without HIV were identified using t-tests.ResultsThe prevalence of depressive symptoms in the participants with DM was 36%. Moderate to severe depression was associated with female gender (p = 0.03) and low educational level (p = 0.02) but not with HIV comorbidity or clinical characteristics of DM. The QOL was influenced by moderate to severe depressive symptoms (QOL in physical p < 0.218 and environmental p < 0.001 domains), but not HIV status (p = 0.218).ConclusionA substantial proportion of people with DM reported depressive symptoms, which is slightly higher than the average reported in other out-patient studies. The association of depression with poor QOL highlights the need for integrated mental health access in medical outpatient services. The lack of association between comorbid HIV status and DM with depression or QOL needs to be further explored.

Going beyond risk factor: Childhood maltreatment and associated modifiable targets to improve life-long outcomes in mood disorders

Childhood maltreatment increases risk for mood disorders and is associated with earlier onset—and more pernicious disease course following onset—of mood disorders. While the majority of studies to date have been cross-sectional, longitudinal studies are emerging and support the devastating role(s) childhood maltreatment has on development of, and illness course in, mood disorders. This manuscript extends prior reviews to emphasize more recent work, highlighting longitudinal data, and discusses treatment studies that provide clues to mechanisms that mediate disease risk, course, relapse, and treatment response. Evidence suggesting systemic inflammation, alterations in hypothalamic–pituitary–adrenal (HPA) axis function and corticotropin-releasing factor (CRF) neural systems, genetic and other familial factors as mechanisms that mediate risk and onset of, and illness course in, mood disorders following childhood maltreatment is discussed. Risky behaviors following maltreatment, e.g., substance use and unhealthy lifestyles, may further exacerbate alterations in the HPA axis, CRF neural systems, and systematic inflammation to contribute to a more pernicious disease course. More research on sex differences and the impact of maltreatment in vulnerable populations is needed. Future research needs to be aimed at leveraging knowledge on modifiable targets, going beyond childhood maltreatment as a risk factor, to inform prevention and treatment strategies and foster trauma-informed care.

Relationship between Mental Disorders and Optimism in a Community-Based Sample of Adults.

Optimism should be included in efforts to protect mental health, as it can provide cognitive resources. Optimism also reduces the negative effects of stressful life events associated with the occurrence and recurrence of mental disorders. This study aimed to evaluate the relationship between mental disorders and optimism in a community-based sample of adults. The study was conducted in three semi-rural clusters determined via random sampling. After adjustment in accordance with the independent variables, the relationship between each psychiatric disorder and Life Orientation Test (LOT) was calculated using logistic models. Overall, 24.5% of participants were categorized into at least one mental disorder group, with 20.8%, 3.5%, and 0.3% having one, two, or three mental disorders, respectively. The median LOT score was lower in patients diagnosed from the Primary Care Evaluation of Mental Disorders modules, except for the somatoform disorder module. Maintaining an optimistic view reduced the risk of mood disorders by 0.86 (OR; 95% CI, 0.81–0.91), anxiety disorders by 0.89 (0.83–0.97), and probable alcohol abuse by 0.83 (0.74–0.93) times after adjustment. The role of an optimistic view in coping with mental problems should be investigated in detail.

Outcomes of critically ill COVID-19 survivors and caregivers: a case study-centred narrative review.

PurposeCritical illness is a transformative experience for both patients and their family members. For COVID-19 patients admitted to the intensive care unit (ICU), survival may be the start of a long road to recovery. Our knowledge of the post-ICU long-term sequelae of acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) may inform our understanding and management of the long-term effects of COVID-19.SourceWe identified international and Canadian epidemiologic data on ICU admissions for COVID-19, COVID-19 pathophysiology, emerging ICU practice patterns, early reports of long-term outcomes, and federal support programs for survivors and their families. Centred around an illustrating case study, we applied relevant literature from ARDS and SARS to contextualize knowledge within emerging COVID-19 research and extrapolate findings to future long-term outcomes.Principal findingsCOVID-19 is a multisystem disease with unknown long-term morbidity and mortality. Its pathophysiology is distinct and unique from ARDS, SARS, and critical illness. Nevertheless, based on initial reports of critical care management for COVID-19 and the varied injurious supportive practices employed in the ICU, patients and families are at risk for post-intensive care syndrome. The distinct incremental risk of COVID-19 multiple organ dysfunction is unknown. The risk of mood disorders in family members may be further exacerbated by imposed isolation and stigma.ConclusionEmerging literature on COVID-19 outcomes suggests some similarities with those of ARDS/SARS and prolonged mechanical ventilation. The pathophysiology of COVID-19 is presented here in the context of early outcome data and to inform an agenda for longitudinal research for patients and families.

Mood disorders in children following neonatal hypoxic-ischemic encephalopathy

Few studies on the consequences following newborn hypoxic-ischemic encephalopathy (NHIE) assess the risk of mood disorders (MD), although these are prevalent after ischemic brain injury in adults. To study the presence of MD in children survivors of NHIE. 14 children survivors of NHIE treated with hypothermia and without cerebral palsy and 15 healthy children without perinatal complications were studied aged three to six years for developmental status (Ages and Stages Questionnaire 3 [ASQ-3]) and for socio-emotional status (Preschool Symptom Self-Report [PRESS] and Child Behavior Checklist [CBCL] 1.5-5 tests). Maternal depression was assessed using Montgomery-Asberg Depression Rating Scale (MADRS). Socio-economic factors such as parental educational level or monthly income were also studied. NHIE children did not present delay but scored worse than healthy children for all ASQ3 items. NHIE children showed higher scores than healthy children for PRESS as well as for anxious/depressive symptoms and aggressive behavior items of CBCL. In addition, in three NHIE children the CBCL anxious/depressive symptoms item score exceeded the cutoff value for frank pathology (P = 0.04 vs healthy children). There were no differences in the other CBCL items as well as in maternal MADRS or parental educational level or monthly income. Neither ASQ3 scores nor MADRS score or socio-economic factors correlated with PRESS or CBCL scores. In this exploratory study children survivors of NHIE showed increased risk of developing mood disturbances, in accordance with that reported for adults after brain ischemic insults. Considering the potential consequences, such a possibility warrants further research.

Elevated Risk of Mood Disorders after the Occurrence of Recurrent Retinal Detachment: A Population-Based Cohort Study

Introduction: The aim of this study was to investigate the risk of mood disorders in patients who experienced retinal detachment (RD) by using the National Health Insurance Research Database in Taiwan. Methods: Participants with a diagnosis of RD were regarded as the study group, and an age- and sex-matched group without a diagnosis of RD served as the control group. The outcomes related to mood disorders after RD included: (1) psychiatric outpatient department visits; (2) behavioural therapy; (3) sleep or anxiety-related disorders; and (4) major depressive disorder (MDD). Results: A total of 4,129 participants diagnosed with RD and 16,516 non-RD individuals were enrolled in the study. There were no significant differences in the four mood disorder-related outcomes between the study and control groups. However, the patients with recurrent RD who received more than two treatments and female patients with RD who needed surgical treatment showed a higher probability of developing MDD than did the non-RD subjects (incidence rate: 0.96 vs. 0.36; adjusted hazard ratio [aHR]: 2.382, 95% confidence interval [CI]: 1.032–5.496, log-rank p = 0.0325; and aHR: 6.895, 95% CI: 1.659–28.656, log-rank p = 0.0060, respectively). Conclusion: Patients with recurrent RD and multiple surgeries and females with RD who needed surgical treatment were at greater risk for developing MDD.

Ehlers-Danlos Syndrome in the Field of Psychiatry: A Review.

Ehlers-Danlos syndrome (EDS) comprises a series of rare hereditary connective tissue diseases characterized by joint hypermobility, joint dislocation, and hyperextensibility of the skin, as well as cardiovascular involvement. EDS is often associated with chronic widespread physical pain, which can lead to psychological pain. Poor awareness and limited diagnosis of EDS and related symptoms result in decreased self-esteem and confusion regarding physical sensation. Furthermore, EDS imposes substantial psychological burden on patients due to exercise restriction, scars, keloids, and subcutaneous fat accumulation on the extremities, which leads to parental overprotection and bullying experiences from other children at school age. Recent large-scale studies have suggested that patients with EDS have a higher risk of mood disorders than the general population. Other cohort studies indicated high prevalence of anorexia nervosa, addiction, obsessive compulsive disorder, and anxiety disorder were found in patients with EDS. Case reports instead indicated that some psychiatric disorders were secondary symptoms due to physical problems from EDS. Therefore, psychiatrists must be more knowledgeable and proactive about EDS in their practice. We review the previous case reports and literature for patients with EDS, along with our own case of complicated psychiatric problems, which are strongly related to early stressful situations through childhood and adolescence. This is to aid general psychiatrists in the discussion of appropriate medical management in such infrequent, yet challenging conditions.

The risk of offspring mood and anxiety disorders in the context of prenatal maternal somatic diseases: a systematic review and meta-analysis

Abstract Aims The importance of prenatal maternal somatic diseases for offspring mood and anxiety disorders may be overlooked or undervalued. We conducted the first systematic review and meta-analysis assessing the risk of offspring mood and anxiety disorders in the context of prenatal maternal somatic diseases. Methods We screened articles indexed in Embase (including Embase, MEDLINE, PubMed-not-MEDLINE), PsycARTICLES and PsycINFO databases up to August 2021. 21 studies were included. We examined the overall associations between prenatal maternal somatic diseases and offspring mood/anxiety disorders. Analyses were stratified according to maternal somatic diseases and follow-up duration. Results We observed an increased risk of mood and anxiety disorders in the context of prenatal maternal somatic diseases [relative risk (RR) = 1.26; 95% confidence interval (CI) 1.15–1.37, RR = 1.31; 95% CI 1.24–1.38]; maternal obesity(RR = 1.92; 95% CI 1.72–2.11), hypertensive disorders (RR = 1.49; 95% CI 1.11–1.86) and infertility (RR = 1.26, 95% CI 1.14–1.39) were risk factors for mood disorders; maternal polycystic ovary syndrome (RR = 1.61; 95% CI 1.42–1.80), severe obesity (RR = 1.56; 95% CI 1.44–1.68) and moderate obesity (RR = 1.36; 95% CI 1.28–1.44) were risk factors for anxiety disorders. Prenatal maternal somatic diseases increased the risk of mood disorders in childhood and adulthood (RR = 1.71; 95% CI 1.34–2.09/RR = 1.19; 95% CI 1.09–1.30), as well as the risk of anxiety disorders in adulthood (RR = 1.33; 95% CI 1.26–1.41). Conclusion The results indicate that prenatal maternal somatic diseases are associated with offspring mood and anxiety disorders, and that the associations may be long-lasting.

Drugs for mood disorders

A variety of treatment modalities are available for the management of depression: prescription medications, psychotherapy, and somatic treatments (electroconvulsive therapy, transcranial magnetic stimulation). Medications and/or psychotherapy are indicated for moderate to severe depressive symptoms, while somatic treatments are used for severe refractory cases. Lifestyle and social support are important to decrease the risk of mood disorders and to alleviate their symptoms.

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Immediate and short-term prevalence of depression in covid-19 patients and its correlation with continued symptoms experience.

Background:The COVID-19 infection can result in prolonged illness in those infected irrespective of disease severity. Infectious diseases are associated with a higher risk of mood disorders. A better understanding of convalescence, symptom duration, as well as the prevalence of depression among recovering patients, could help plan better care for the survivors of COVID-19.Aim:The study aimed to estimate the immediate and short-term prevalence of major depressive disorder and its correlation with continued symptom experience.Methods:In this non-interventional, observational, and cross-sectional telephone survey study, 273 participants were included from January 2021 to April 2021 and 261 completed follow-up by July 2021. The symptoms at the time of RT-PCR testing and during the two phone calls were captured and the Patient Health Questionnaire 9 item (PHQ-9) version was administered.Results:During the immediate and short-term period following COVID-19, 144/261 (55.1%) and 71/261 (27.2%) patients had not returned to usual health, respectively, and 33/261 (12.8%) and 13/261 (5%) of the patients developed depression, respectively. The binary logistic regression analysis revealed that the independent predictors of depression in short-term period following COVID-19 were comorbid diabetes mellitus (OR = 32.99, 95% CI- 2.19-496, P = 0.011), number of symptoms at the time of RT-PCR testing (OR = 1.89, 95% CI 1.23-1.92, P = 0.018), and number of symptoms at short-term period following COVID-19 (OR = 2.85, 95% CI 1.47-5.51, P = 0.002).Conclusions:Individuals with a greater number of symptoms at the time of RT-PCR testing, with post-COVID symptoms persisting 3 months later, and those who have comorbid diabetes mellitus, are at greater odds to have comorbid depression.

Therapeutic alliance in family therapy and clinical outcomes among adolescents at risk for mood disorders

BackgroundFamily-focused therapy (FFT) is associated with longer intervals between mood episodes and reductions in suicidal ideation among adolescents at risk for bipolar disorders. However, the mediating processes underlying the efficacy of FFT are not well understood. In an open trial of an 18-week FFT program, we explored the association between the therapeutic alliance of adolescents/parents with their therapists and the symptomatic outcomes of adolescents over 18 weeks. MethodParticipants were enrolled in a treatment development trial of FFT supplemented with a mobile app. We used the System for Observing Family Therapeutic Alliances (SOFTA) to rate alliance between adolescents, parents, and therapists using videotaped FFT sessions from the beginning and end of treatment. Pearson correlations were computed between SOFTA alliance ratings and changes in Children's Depression Rating Scale, Revised (CDRS-R) scores over 18 weeks of treatment. ResultsSOFTA ratings were obtained from sessions conducted with 17 adolescents (mean age 14.9+/-2.0 years; 41.2% female) and 22 parents. CDRS-R ratings were obtained from 16 adolescents at baseline and 18 weeks. Parents had significantly higher levels of engagement and emotional connection with therapists than their offspring. Adolescents’ therapeutic engagement scores were significantly correlated with reductions in CDRS scores over 18 weeks (r(14) = -0.58, p = 0.018; N = 16). LimitationsWe could not draw conclusions about the causal relationship between therapeutic alliance and improvement in depression. ConclusionsAmong high-risk adolescents undergoing FFT, therapeutic alliance is associated with clinical improvement over 4 months. Strategies to enhance adolescent engagement may strengthen the long-term effects of family interventions.

Association of Dual Sensory Impairment with Long-term Depressive and Anxiety Symptoms

Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often relied upon to provide daily support to their care recipients. However, research on the differing experiences of caregivers based on care recipient diagnosis is limited. The aim of this study was to examine the impact of worry and feelings of vigilance among caregivers of people with cognitive impairment due to either TBI or dementia. This sample included 61 caregivers (88.5% female, mean age 57.3±15.5) of persons with either a TBI (n = 32) or dementia (n = 29). Worry was assessed with the Penn State Worry Questionnaire and Vigilance was assessed with the Caregiver Vigilance Scale. Linear regressions revealed that after controlling for age, care recipient diagnosis moderated the relationship between worry and caregiver vigilance. Specifically, worry was significantly associated with caregiver vigilance in those caring for someone with dementia; however, a similar relationship was not seen in those caring for someone with a TBI. This suggests caregivers of people with TBIs have a different experience of worry and vigilance than caregivers of people with dementia. These findings demonstrate the need for more research on the unique needs of caregivers of people with TBIs. Additionally, this research suggests interventions targeting worry may be particularly effective in supporting caregivers of people with TBIs.

Long-term Follow-up of Psychiatric Disorders in Children and Adolescents Conceived by Assisted Reproductive Techniques in Sweden

Individuals conceived with assisted reproductive techniques (ARTs) could be at elevated risk of psychiatric disorders owing to potential adverse effects of the procedures themselves, or because such traits or their risk factors may be more common in couples with infertility. To investigate the risk of psychiatric disorders in adolescents and young adults conceived with ARTs and to evaluate the role of treatment-related parental characteristics. This prospective follow-up of a nationwide birth cohort used linkage of Swedish population registers with coverage through 2018. All children born in Sweden from January 1, 1994, to December 31, 2006, were included in the analysis. Follow-up was completed on December 31, 2018, when participants were 12 to 25 years of age, and data was analyzed from March 17, 2020, to September 10, 2021. In vitro fertilization with or without intracytoplasmic sperm injection and transfer of fresh or frozen-thawed embryos. Clinical diagnoses of mood disorder, including major depression, anxiety, obsessive-compulsive disorder (OCD), or suicidal behavior, were identified from hospital records and outpatient specialist care. Suicide was additionally identified from death certificates. Antidepressant use was identified from dispensations of prescribed medications. A total of 1 221 812 children (48.6% female, 51.4% male) born between 1994 and 2006 were followed up to a median age of 18 (IQR, 15-21) years. Among these participants, 31 565 (2.6%) were conceived with ART. Compared with all others, adolescents conceived with ART had an elevated risk of OCD (hazard ratio [HR], 1.35 [95% CI, 1.20-1.51]), but the association was attenuated and no longer statistically significant after adjustment for parental characteristics (adjusted HR [aHR], 1.10 [95% CI, 0.98-1.24]) and was no longer present when restricted to individuals born to couples with known infertility (aHR, 1.02 [95% CI, 0.89-1.17]). Adolescents conceived with ARTs were not at elevated risk of depression or suicidal behavior compared with other adolescents (irrespective of parental infertility). Type of fertilization (standard in vitro fertilization or intracytoplasmic sperm injection) had no association with outcomes. Compared with non-ART-conceived children of couples with infertility, fresh, but not frozen, embryo transfer was associated with a lower risk of mood disorders (aHR, 0.90 [95% CI, 0.83-0.97]), making frozen embryo transfer appear less advantageous when directly contrasted with fresh embryo transfer. These findings suggest that adolescents conceived with ARTs around the millennium are not at risk of poor psychiatric health compared with the general population, except for an elevated risk of OCD that may be explained by differences in parental characteristics.