Youth Depression Research Articles

A nomogram for predicting non-suicide self-injury in youth depression patients: a longitudinal analysis

A nomogram for predicting non-suicide self-injury in youth depression patients: a longitudinal analysis

Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV.

Background: Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.Method: Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.Results: Both COMB-R (n = 69) and ESC (n = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (p = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (p = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (p = 0.52).Discussion: Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.Conclusion: While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.

Anxiety, depression, and headache-related disability in a large pediatric clinic-based sample.

To explore the relationships among anxiety, depression, and headache-related disability in a pediatric clinic-based retrospective cross-sectional study. Anxiety and depression are commonly considered comorbidities of headache disorders and are frequently seen in children and adolescents. These conditions can contribute to disability and may have a cumulative impact. In this study, we tested whether self-reported anxiety and/or depression in youth were associated with headache-related disability. This was a retrospective cross-sectional study of children ages 6-17 years old who completed a headache intake questionnaire at the time of a new outpatient neurology visit. Those who reported on behavioral health symptoms, involvement of a behavioral health provider (i.e., yes/no), and the PedMIDAS (a validated metric of headache-related disability) were included. The relationship between anxiety and/or depression and headache-related disability was examined. Of the 12,660 questionnaires queried, 9118 met criteria for inclusion. Respondents were 64.0% female and had a median age of 13.5 years (interquartile range [IQR] 10.3, 15.7). Compared to patients without self-reported anxiety/depression, patients with anxiety and depression reported higher headache-related disability (M = 17.0, [IQR 6.0, 41.0]) even after accounting for covariates (estimated difference = 6.0, 95% confidence interval [CI: 4.4-7.5]). For participants with anxiety and/or depression, having a behavioral health provider was associated with greater headache-related disability (estimated difference = 7.0; 95% CI 4.6-9.3). Patients with self-reported anxiety and/or depression reported higher headache-related disability. Having a behavioral health provider was associated with greater headache-related disability, indicating the complexity and high level of need for this population. Further research is needed to understand the directionality of these results; however, patients with headache as well as depression and or anxiety are a vulnerable group who may benefit from an integrated care model.

Evidence-Base Update of Psychosocial and Combination Treatments for Child and Adolescent Depression

ABSTRACT Objective This evidence-based update (EBU) builds on three previous reviews (1998, 2008, 2017) sponsored by the Society of Clinical Child and Adolescent Psychology with the aim of evaluating the empirical support for psychosocial interventions for depression in youth. Method In the current review period (2014–2022), 25 randomized controlled trials (RCT) were identified: four in children and 21 in adolescents. Descriptive effect sizes and number-needed-to-treat (NNT) ratios were calculated for primary outcomes. Results were integrated with prior reviews, and cumulative evidence used to classify treatments as well-established, probably efficacious, possibly efficacious, or experimental. Published secondary analyses of predictors, moderators, and mediators were examined. Results For adolescents, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT-A), CBT in combination with antidepressant medication, and collaborative care programs were all classified as well-established. The evidence was considerably weaker for children, with no treatments achieving well-established or probably efficacious status. New developments include greater exploration of parent- and family-mediated treatment models and increasing evidence on technology-assisted interventions. Data on predictors, moderators, and mediators continued to be focused on adolescent depression samples and drawn from a limited number of RCT datasets. Conclusion Since the prior EBU, there has been incremental progress in youth depression treatment research. There is an urgent need to: (a) develop innovative approaches to substantially improve on the modest effects seen in most RCTs, (b) expand the evidence base for children and other underserved groups, (c) craft evidence-based guidelines for choosing between interventions when multiple efficacious treatments do exist, and (d) address issues of treatment effectiveness and scalability to ameliorate the wide prevalence and high impact of depression in youth.

Probing Neurophysiological Processes Related to Self-Referential Processing to Predict Improvement for Depressed Adolescents Receiving Cognitive Behavioral Therapy

BACKGROUNDCognitive Behavior Therapy (CBT) is a gold standard approach for treating major depressive disorder (MDD) among adolescents. However, nearly half of adolescents receiving CBT do not improve. In order to personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. Toward addressing this aim, this study investigated neurophysiological processes related to self-referential processing that predicted CBT response among depressed, female adolescents. METHODSAt baseline, female adolescents ages 13-18-years-old (N=80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalogram (EEG) data were recorded. Baseline EEG data were utilized to identify oscillatory differences between healthy (HC, n=38) and depressed (MDD, n=42) adolescents. Following the baseline assessment, depressed youth received up to 12-weeks of CBT. Baseline differences in EEG oscillations between healthy and depressed youth were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis (ERSP) probed theta and alpha event-related synchronization/desynchronization (ERS/ERD) response to negative and positive words. RESULTSBaseline analyses showed that, relative to the healthy adolescents, depressed youth exhibited higher levels of frontal theta ERS and a greater posterior alpha ERD. Multilevel modeling identified primary neural pre-treatment predictors of treatment response: greater theta ERS in the right prefrontal cortex (PFC) after the onset of negative words and lower alpha ERD in both the right PFC and posterior cingulate cortex (PCC). ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses. CONCLUSIONSConsistent with prior research, results highlighted that relative to healthy youth, depressed adolescents are characterized by prominent theta synchronization and alpha desynchronization over PFC and PCC, respectively. Cluster-based ERSP analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the CBT course. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.

Gender and Lower Economic Status Moderate the Relation between Positive Youth Development and Mental Health.

Adolescent mental health problems account for almost half of overall health problems globally with a risk to mental health in adulthood. Since most mental health problems begin in adolescence, this developmental period should be a focus of strengths-based approach and prevention. The most researched positive youth development framework shown to be associated with youth mental health is The Five C model which distinguishes five indicators: competence, character, confidence, caring, and connection. The aim of the present study is to examine whether sociodemographic differences moderate the association of Five Cs positive youth development indicators and depression and anxiety symptoms in adolescence. The participants of the study were 3,438 students enrolled in the first year of secondary schools in Croatia who completed the Short Measure of the Five Cs, Depression Anxiety and Stress Scales and reported the perception of the socioeconomic status of their family. Gender and socioeconomic status main effects were shown for seven out of ten models with depression and anxiety as criterion variables. Results show that girls with lower levels of competence, confidence, and connection and lower socioeconomic status reported the highest depression and anxiety scores. These results imply that confidence, competence, and connection could be sensitive to equality and distribution of resources for youth. Reducing youth mental health problems should include social justice perspective and more available public services for families. Supportive environments are key for positive development; therefore, promotive and preventive efforts should target factors operating on societal level as well.

Discrimination, critical consciousness, and mental health in American youth of color.

To resist and cope with oppression, youth of color may use the process of critical consciousness which involves understanding racial injustices (critical reflection), developing motivation to fight these injustices (critical motivation), and taking action to enact sociopolitical change (critical action). However, little is known about how each dimension of critical consciousness affects mental health in adolescents of color. In a sample of 367 ethnically and racially diverse American adolescents of color (age range = 13-17; 68.9% girls, 28.6% boys, and 2.5% gender minority; 84.4% US-born), we conducted multivariate regressions in Mplus to examine the cross-sectional links between each critical consciousness dimension (reflection, motivation, and action) and mental health outcomes (anxiety, depression, and stress) over and above the impact of everyday discrimination. We also investigated the interaction between critical consciousness and discrimination in predicting mental health outcomes. Controlling for age, gender, nativity, and social class, we found that discrimination and critical action were both positively associated with anxiety, depression, and stress. For our covariates, girls and gender minority adolescents reported worse outcomes. No interactions were significant. Overall, critical action, while necessary to enact societal change, may have a complex relationship with youth's depression, anxiety, and psychological stress symptoms and warrants careful exploration. Future research should focus on understanding the longitudinal mechanisms of critical action and how we can maximize the benefits by protecting youth from those negative effects.

Seasonal mood variation in youth and young adults with bipolar spectrum disorder: A longitudinal prospective analysis

ObjectiveTo determine whether there are latitude and seasonal differences in the prevalence of mood episodes (depression and mania) in youth and young adults with Bipolar Spectrum Disorder (BD). MethodsMood polarity was prospectively evaluated in 413 participants with BD. Participants were enrolled in the Course and Outcome of Bipolar Youth (COBY) study at three sites (University of California Los Angeles-UCLA, Brown University, and the University of Pittsburgh Medical Center-UPMC) and interviewed on average every 7 months for an average of 91.9 months (range: 6–228 months), with a total of 274,123 weekly mood ratings. Associations between light exposure and mood polarity were estimated using generalized linear mixed models with time-varying covariates, considering the latitude and seasonality of the study sites and other potential confounders. ResultsAverage age at intake and at last assessment was 12.6 ± 3.3 and 27.2 ± 4.8 years-old, respectively. There were significantly more depressive episodes during winter than during summer, spring, and autumn. Considering latitude, UCLA showed significantly lower prevalence of depressive episodes, and an absence of seasonal pattern of depression, compared to the Brown/UPMC sites. For the entire sample, there were more manic/hypomanic episodes during summer than during winter. However, there were no significant between site seasonal differences in the prevalence of manic/hypomanic episodes. ConclusionsDepressive episodes are more prevalent during the winter and although less significant, manic/hypomanic episodes during the summer. Awareness and interventions to prevent or ameliorate the effects of seasonal variations in mood changes in BD are warranted.

A Discrepancy in the Reports on Life Events Between Parents and Their Depressed Children Is Associated with Lower Responsiveness to SSRI Treatment.

Introduction: Exposure to a range of stressful life events (SLE) is implicated in youth psychopathology. Previous studies point to a discrepancy between parents'/children's reports regarding stressful life events. No study systematically assessed the correlation between such discrepancies and psychopathology in depressed youth. This study was designed to assess parent-youth discrepancies regarding stressful life events and its association with severity of psychopathology at baseline and response to selective serotonin reuptake inhibitor (SSRI) treatment in depressed youth. Methods: Reports regarding stressful life events were assessed in children/adolescents suffering from depressive/anxiety disorders using the life events checklist (LEC), a self-report questionnaire measuring the impact of negative life events (NLE) and positive life events (PLE), as reported by the children and their parents. The severity of depression/anxiety disorders and response to antidepressant treatment were evaluated and correlated with both measures of LEC. Results: Participants were 96 parent-child dyads (39 boys, 57 girls) aged 6-18 years (mean = 13.90 years, SD = 2.41). Parents reported more NLE and higher severity of NLE events than their children (number of NLE: 7.51 ± 4.17 vs. 6.04 ± 5.32; Cumulative severity of NLE: 24.95 ± 14.83 vs. 17.24 ± 12.94). Discrepancy in PLE, but not NLE, was associated with more severe psychopathology and reduced response to treatment. Discussion: Discrepancy in informant reports regarding life events in depressed/anxious youth, especially regarding PLE, is associated with more severe psychopathology and reduced response to pharmacotherapy. It is essential to use multiple reporters in assessing stressful life events in children.

Evaluating depression in Indonesian adolescents with epilepsy: Comprehensive validation and reliability assessment of the neurological disorders depression inventory-epilepsy for youth Indonesian version (NDDI-E-Y[ID]).

Epilepsy is a common chronic neurological disorder in pediatrics. Depression is an often underdetected comorbidity in childhood epilepsy. This study aimed to adapt the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y) to the Indonesian language and population, as well as to validate the Indonesian version of NDDI-E-Y (NDDI-E-Y[ID]). This three-stage study comprised instrument translation, cultural verification, and content validity testing (first stage), pilot testing (second stage), followed by concurrent validity and reliability testing (third stage) of the NDDI-E-Y(ID). Validation was done against the Centre for Epidemiologic Studies Depression Scale - Revised (CESD-R). Content validity, assessed by six experts, was quantified using the content validity index for items (I-CVI) and scale (S-CVI). Participants were adolescents aged 12-17 years diagnosed with any type of epilepsy who completed both instruments. Concurrent validity was evaluated using Spearman's correlation and reliability was measured using Cronbach's alpha. The first stage produced a culturally appropriate NDDI-E-Y(ID). Thirty healthy adolescents and 10 adolescents with epilepsy participated in the second stage. In the third stage, another group of 30 adolescents with epilepsy took part. We obtained I-CVI and S-CVI values averaging 1. The NDDI-E-Y(ID) showed a positive and significant correlation with CESD-R (Spearman's rho = 0.671, p < 0.001). A Cronbach's alpha of 0.928 reflected a high internal consistency. Based on the results, the NDDI-E-Y(ID) was found to be a valid and reliable screening instrument for detecting depression in youth with epilepsy. Depression is an under-recognized problem in youth with epilepsy. Currently available depression screening tools are in English, making it less suitable for detection purposes in Indonesia. This study developed and validated the Indonesian version of the NDDI-E-Y, a depression screening tool for youth with epilepsy.

Parenting strategies to support adolescent mental health during a pandemic: A Delphi consensus study

BackgroundThe COVID-19 pandemic has had ongoing detrimental effects on mental health, especially for young people. Parents can play a crucial role in the prevention of youth depression and anxiety disorders. While parenting guidelines for reducing the risk of adolescent depression and anxiety have been developed, they needed to be adapted for the unique challenges brought by a pandemic. MethodThis study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing adolescent depression or anxiety disorders during a pandemic. Through a literature search and panel recommendations, we identified 304 parenting recommendations. These were presented to an international panel of 35 experts in parenting and youth mental health, who rated the importance of these recommendations in preventing adolescent depression and anxiety over three survey rounds. ResultsThere were 167 parenting strategies endorsed as important or essential in reducing adolescents' risk of developing depression or anxiety disorders during a pandemic by ≥90% of the panel. These strategies were written into a set of specific and actionable guidelines for parenting through the pandemic, and made freely available online for parents. ConclusionsThis study adapted an original set of parenting guidelines for the COVID-19 pandemic, supported by research evidence and/or international experts, which can be promoted in Western English-speaking communities to help parents protect their adolescents from depression and anxiety disorders during pandemic and post-pandemic times.

A mega-analysis of functional connectivity and network abnormalities in youth depression

A mega-analysis of functional connectivity and network abnormalities in youth depression

Mapping connectivity and network alterations in youth depression by functional brain imaging

Mapping connectivity and network alterations in youth depression by functional brain imaging

Investigating Functional Connectivity in Adolescent Depression and Suicide Attempt during Neurofeedback Sessions: A Multivariate Random Covariance Model Approach

Background A recent neurofeedback functional magnetic resonance imaging (NF, fMRI) study on depressed vs. healthy adolescents elicited differential functional connectivity (FC) amongst brain regions of interest (ROIs). Previous results employed univariate methods and included only two seed areas of FC (amygdala and hippocampus). In this study, we propose a new multivariate analysis for whole-network FC estimation. Methods Primary analyses concerned a pre-identified network of 17 salient ROIs reflecting key regions in self-processing and emotion regulation. A random covariance model (RCM) was applied to jointly estimate participant- and group-specific connectivity, where FC was measured by partial correlation conditioned on or adjusted for rest-of-network connectivity patterns. Secondary analyses concerned participant-specific network association with mental functioning changes and the AAL3 whole-brain atlas. Results New findings suggested that depressed adolescents with a suicide attempt expressed significantly higher positive FC between the left temporal gyrus and the left amygdala during NF, compared to negative FC in non-attempting depressed youth, while healthy controls displayed negative FC between the insula, inferior frontal gyrus to inferior parietal lobe connection, compared to mild negative connectivity in depressed adolescents. Previous cross-hemispheric findings in depressed vs. healthy adolescents were corroborated. Conclusion A multivariate RCM uncovered key ROI-pairwise connections differentiating FC patterns between depressed youth vs. healthy controls and among depressed youth, with and without a suicide attempt. Findings were strengthened by enhanced inference vs. univariate methods, and corroboration of previous NF secondary analyses demonstrated future utility for participant-specific study in association with clinical outcomes and/or whole-brain analyses with larger sample sizes.

Anxiety and Depression in Youth With Chronic Pain

For youth with chronic pain, anxiety and depression are reported as consequences of experiencing pain and maintaining factors of ongoing pain and disability. However, prevalence estimates of anxiety and depression remain unclear. To report the prevalence of clinical anxiety and depression for youth with chronic pain and compare symptoms of anxiety and depression between youth with and without chronic pain. MEDLINE, PsycINFO, CENTRAL, and Embase from inception to April 30, 2023. Included studies that reported prevalence data or symptom scores for anxiety and/or depression in individuals younger than 25 years (mean, ≤18 years) with chronic pain and were published in English. From 9648 nonduplicate records, 801 full-text articles were screened. Screening and data extraction occurred in duplicate. Prevalence was determined using event rate calculations. Between-group symptom differences were calculated using Hedges g. Analyses were conducted using the random-effects model. Reporting bias and Grading of Recommendation, Assessment, Development, and Evaluation assessments were conducted. Prevalence of anxiety and depression (based on diagnosis and clinical cutoff scores) and differences in anxiety and depression symptoms. Moderators of prevalence and symptom differences were analyzed when data allowed. A total of 79 studies were included with a total sample of 22 956 youth (n = 12 614 with chronic pain). Most youth were female (mean, 74%), with an age range of 4 to 24 (mean [SD], 13.7 [2.10]) years. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI, 24.0%-47.0%) and the portion that exceeded clinical cutoff scores was 23.9% (95% CI, 18.3%-30.6%). The prevalence of depression diagnoses was 12.2% (95% CI, 7.8%-18.7%) and the portion that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%). Youth with chronic pain had greater symptoms of anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85) compared with controls. Sex, age, pain location, and recruitment sample may moderate anxiety and depression. Considerable heterogeneity was reported for all outcomes. Studies had a low reporting bias, and outcomes were moderate to high quality. The findings of this meta-analysis suggest that 1 in 3 youth with chronic pain meet criteria for anxiety disorder, and 1 in 8 meet criteria for a depressive disorder. This represents a major clinical comorbidity. Moving forward, screening, prevention, and treatment of mental health should be important health care priorities for youth with chronic pain.

Assessing Clinical and Cognitive Outcomes in Depressed Youth Following Chronic Cardiovascular Exercise

Cardiovascular exercise is an empirically supported treatment for major depressive disorder (MDD); however, its effect on cognitive functioning is understudied. We examined how cardiovascular exercise influenced cognitive functioning in healthy youth and youth with MDD aged 16-24 (N = 51). We also assessed how twelve weeks of aerobic exercise intervention influenced cognitive functioning and depressive symptoms in youth with MDD. The Beck Depression Inventory (BDI) was used to measure depressive symptoms and the NIH Cognition Toolbox was used to calculate fluid and crystallized cognition composite scores. We expected increased cognitive functioning to correlate with larger decreases in MDD symptoms. We found no significant differences in baseline cognition scores between healthy and depressed youth. There were no significant differences between changes in VO2 max (an index of cardiovascular fitness) and depressive symptoms or cognition scores in depressed youth. We found a trend for an improvement in cognition scores after exercise intervention, suggesting that consistent cardiovascular exercise could enhance cognition. This study advances our understanding of aerobic exercise as a treatment modality for youth with MDD and the importance of alternative therapeutic interventions in depression.

Prevalence, Symptom Profiles, and Correlates of Mixed Anxiety-Depression in Male and Female Autistic Youth.

Relatively little attention has been given to mixed anxiety and depression in autistic youth, particularly how this differs between males and females. This study investigated sex-based differences in the prevalence and correlates of mixed anxiety and depression in a sample of 51 autistic males (M age = 10.16 yr, SD = 2.81 yr, and range = 6 yr to 17 yr) and 51 autistic females (M age = - 10.07 yr, SD = 2.76 yr, and range = 6 yr to 17 yr), matched for age, IQ, and autism severity. Self-reports on generalised anxiety disorder and major depressive disorder, morning salivary cortisol, ADOS-2 scores, and WASI-II full-scale scores were collected from these autistic youth, and data on the ASD-related symptoms of these youth were collected from their parents. The data were analysed for total anxiety-depression score levels, for the underlying components of this scale, and for the individual items used in the scale. The results indicate no significant sex differences for the prevalence of mixed anxiety and depression total scores or the underlying components of anxiety and depression or for the individual items of the mixed anxiety-depression scale. There were sex differences in the significant correlates of mixed anxiety and depression: morning cortisol and ASD-related difficulties in social interaction for females, and ASD-related behaviour for males. Males' feelings of being restless or edgy were correlated with their social interaction and repetitive and restricted behaviour. Females' difficulties in social interaction were correlated with their concerns about their abilities and their sleeping problems. Females' sleeping problems, their tendency to talk about dying, and feeling worthless, were correlated with their morning cortisol. These findings suggest that, while mixed anxiety and depression is experienced similarly by autistic males and females at the global, component, and individual item levels, specific aspects of the symptomatology of mixed anxiety and depression are differently associated with aspects of their ASD-related symptomatology and their levels of chronic physiological stress for males and females.

Interventional approaches to treatment resistant depression (DTR) in children and adolescents: A systematic review and meta-analysis

BackgroundMajor depressive disorder (MDD) is highly prevalent in youth. Conventional treatment paradigms primarily involve selective serotonin reuptake inhibitors (SSRIs) and psychotherapy, yet a significant proportion of this population exhibits treatment-resistant depression (TRD). In adults, interventional therapies like Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS), and ketamine have shown promise for TRD, but their comparative efficacy remains underexplored in Adolescent and pediatric population. This systematic review and meta-analysis aims to assess the relative effectiveness of ECT, rTMS, and ketamine in treating TRD among adolescents. MethodsFollowing PRISMA guidelines, we systematically searched databases for studies of ECT, rTMS, or ketamine for treatment-resistant depression in youth ages 10–24. Three reviewers independently screened for inclusion based on predefined criteria. Included observational and randomized controlled trials reported depression symptoms with measures like HDRS and MADRS in youth treated with ECT, rTMS, or ketamine. Two reviewers extracted data on interventions, patients, and depression symptom outcomes. Chance-adjusted inter-reviewer agreement was calculated. For meta-analysis, we pooled standardized mean differences (SMDs) in depression scores using random effects models and assessed heterogeneity with I2 statistics. ResultsMeta-analysis of 10 observational studies examined SMD in depression scores for treatment resistant depression patients treated with ECT, ketamine, or rTMS. Patients treated with ECT had a significantly lower SMD of 1.99 (95 % CI 0.92–3.05, p < 0.001) compared to baseline. Patients treated with ketamine also had a significantly lower SMD of 1.58 (95 % CI 1.04–2.12, p < 0.001). Patients treated with rTMS had the lowest SMD of 2.79 (95 % CI 0.79–4.80, p = 0.006). There was no significant difference between the three groups overall (p > 0.05). Comparative analysis between ECT and ketamine found no significant difference in SMD (p = 0.387). Comparison of ECT versus rTMS found a significant difference in SMD favoring rTMS (p = 0.004). Comparison of ketamine versus rTMS suggested a potential difference in SMD favoring rTMS (p = 0.058). In summary, rTMS resulted in significantly larger reductions in depression scores than ECT, and potentially larger reductions than ketamine. ConclusionsThis meta-analysis illustrates the ability of rTMS, ECT, and ketamine to improve depression in youth. rTMS resulted in the largest improvements, highlighting its potential as a first-line treatment for pediatric treatment-resistant depression given its favorable side effect profile compared to ECT. Further research directly comparing these modalities is needed.

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth

PurposeLGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs. MethodsData come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality. ResultsThe study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time. DiscussionTGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

Symptom network analysis of parent-child depression and anxiety in treatment-seeking youth.

Youth of parents who are experiencing psychopathology are more likely to develop emotional concerns, and these mental health symptoms can have a deleterious impact on parents' mental health. However, the relationship between the presentation of specific symptoms in parents and youth is infrequently examined. Symptom network analysis is an analytic approach that is increasingly being used to better understand the relationship of symptoms within and between disorders and can also be used to examine symptom relations within a dyad. The present study used symptom network analysis to examine bidirectional relationships among depressive and anxiety psychopathology in a transdiagnostic sample of treatment-seeking youth and their primary caregiver. Parental anhedonia and child worthlessness exhibited the greatest centrality within the network, suggesting that these may act as risk and maintenance factors for parent-child psychopathology and may be important intervention targets. Findings support the use of symptom network analysis to inform an understanding of the complex relationships among parent and child depressive and anxiety symptoms. Future research should consider the use of network analytic methods to examine the temporal relationships between parent and child psychopathology and to inform joint parent-child interventions for those with internalizing concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).