Predicting recurrence of major depressive disorder in young adults: a prospective study.

Sixty-five young adults with remitted major depressive disorder (MDD) were followed for 18 months. Recurrence of MDD was reported by 41.5% of the initial sample and 49.1% of those who completed the study (n = 53). Survival analyses were used to identify predictors of recurrence so that individuals at greatest risk could be targeted for intervention. Potential predictors included measures of comorbid psychopathology (Axis II pathology, and current and lifetime nonmood Axis I diagnoses), depression-specific clinical features (number of episodes, past treatment, and suicidality), and self-reported cognitive and interpersonal constructs (hope, dysfunctional attitudes, and interpersonal problems). Only personality pathology (specifically, the total dimensional and Cluster B dimensional scores on the International Personality Disorder Examination) significantly predicted hazard of recurrence.     

Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence

The authors examined whether adolescent major depressive disorder (MDD) was associated with difficulties in young adult functioning and whether differences would remain significant after accounting for nonmood disorder, MDD recurrence, functioning in adolescence, or current mood state. A total of 941 participants were assessed twice during adolescence and at age 24. In unadjusted analyses, adolescent MDD was associated with most young adult functioning measures. Associations were not due to interactions with adolescent comorbidity, but differences in global functioning and mental health treatment appeared as a result of MDD recurrence. Accounting for levels of functioning in adolescence or for current depression at age 24 eliminated the remaining associations. The implications of these findings for efforts to prevent MDD in adolescence are discussed.     

Evaluation of cognitive diathesis-stress models in predicting major depressive disorder in adolescents

Diathesis-stress predictions regarding the onset of adolescent major depression and nonmood disorders were tested. Adolescents (N = 1,507) were assessed for dysfunctional attitudes and negative attributional style, as well as current depressive symptoms, current depressive and nondepressive diagnoses, and past and family histories of psychopathology. Approximately 1 year later, participants were reassessed on all measures. Analyses supported A. T. Beck's (1976) theory of depression (at the level of a trend) but not the hopelessness theory of depression. Findings were suggestive of a threshold view of vulnerability to depression; for those who experienced negative life events, depressive onset was related to dysfunctional attitudes but only when dysfunctional attitudes exceeded a certain level (low = intermediate < high). For participants who scored either very high or very low on both dysfunctional attitudes and negative attributional style, nonsignificant findings were obtained.     

Neural correlates of rumination in adolescents with remitted major depressive disorder and healthy controls

The aim of the present study was to use fMRI to examine the neural correlates of engaging in rumination among a sample of remitted depressed adolescents, a population at high risk for future depressive relapse. A rumination induction task was used to assess differences in the patterns of neural activation during rumination versus a distraction condition among 26 adolescents in remission from major depressive disorder (rMDD) and in 15 healthy control adolescents. Self-report depression and rumination, as well as clinician-rated depression, were also assessed among all participants. All of the participants recruited regions in the default mode network (DMN), including the posterior cingulate cortex, medial prefrontal cortex, inferior parietal lobe, and medial temporal gyrus, during rumination. Increased activation in these regions during rumination was correlated with increased self-report rumination and symptoms of depression across all participants. Adolescents with rMDD also exhibited greater activation in regions involved in visual, somatosensory, and emotion processing than did healthy peers. The present findings suggest that during ruminative thought, adolescents with rMDD are characterized by increased recruitment of regions within the DMN and in areas involved in visual, somatosensory, and emotion processing.     

Gender differences in major depressive disorder and bipolar disorder

This paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not been found. In BPD, women are more likely than men to develop a rapid-cycling course. Gender differences in treatment response, particularly in regard to mood stabilizing medications, warrant further study.     

Cigarette smoking and depressive symptoms: a longitudinal study of adolescents and young adults

Cigarette smoking and depressive symptoms have been shown to be related in previous research. This paper examined the relationship between cigarette smoking and depressive symptoms in a longitudinal sample of 688 adolescents and young adults through surveys conducted over 13 yr. The results indicate that a history of earlier cigarette smoking in adolescence predicts later depressive symptoms in the late twenties. The study also suggests that depressive symptoms during adolescence predict cigarette smoking in the late twenties but not above and beyond prior smoking. These results help clarify and expand current knowledge on the links between cigarette smoking and depression. The results point to several clinical implications for treatment of both cigarette smoking and depressive symptoms among both adolescents and young adults.     

Reward-related brain function as a predictor of treatment response in adolescents with major depressive disorder

The present study provides preliminary evidence that pretreatment reward-related brain function in the striatum and medial prefrontal cortex (PFC) could have relevance for predicting both final level and rate of change of clinical characteristics in adolescents with major depressive disorder. Adolescents with depression underwent a functional MRI scan during a monetary reward task, participated in an 8-week open trial of cognitive behavioral therapy (CBT) or CBT plus selective serotonin reuptake inhibitor, and completed reports of anxiety and depressive symptoms before, during, and after treatment. Clinicians rated adolescents’ improvement and severity at the same time points. Growth models were used to examine change in clinical characteristics and its association with brain function. Severity, anxiety symptoms, and depressive symptoms decreased over treatment. Final levels of severity and anxiety symptoms were associated with pretreatment striatal reactivity, and rate of anxiety symptom reduction was associated with greater striatal reactivity and lower medial PFC reactivity.     

Crying threshold and intensity in major depressive disorder

Clinical lore suggests that depression is associated with frequent and intense crying. To test these postulations empirically, a standardized cry-evoking stimulus was presented to depressed and nondepressed participants, and their likelihood of crying and the magnitude of crying-related changes in their emotion experience, behavior, and autonomic physiology were compared. Unexpectedly, crying was no more likely in depressed than in nondepressed participants. Within the nondepressed group, participants who cried exhibited increases in the report and display of sadness and had greater cardiac and electrodermal activation than did participants who did not cry. There was less evidence of this crying-related emotional activation within the depressed group. The lack of emotional activation among clinically depressed participants who cried provides a tantalizing clue concerning how emotions are dysregulated in this disorder.     

Diurnal mood variation in major depressive disorder

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons' NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals'. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect.     

Emotion context insensitivity in major depressive disorder

The present study tested 3 competing views of how depression alters emotional reactivity: positive attenuation (reduced positive), negative potentiation (increased negative), and emotion context insensitivity (ECI; reduced positive and negative). Normative and idiographic stimuli that elicited happy, sad, and neutral states were presented to currently depressed, formerly depressed, and healthy control individuals while experiential, behavioral, and autonomic responses were measured. Currently depressed individuals reported less sadness reactivity and less happiness experience across all conditions than did the other participants, and they exhibited a more dysphoric response to idiographic than to normative stimuli. Overall, data provide partial support for the positive attenuation and ECI views. Depression may produce mood-state-dependent changes in emotional reactivity that are most pronounced in emotion experience reports.     

Idiographic autobiographical memories in major depressive disorder

When cued with generic happy and sad words, depressed individuals have been found to articulate contextually impoverished, overgeneral memories of both positive and negative autobiographical events. The current study tested whether overgeneral memory is observed outside of the cue-word paradigm. Currently depressed, formerly depressed, and never-depressed controls underwent an idiographic interview procedure in which participants generated memories of their happiest and saddest lifetime events. Although depressed and nondepressed participants did not differ with respect to the specificity, retrieval difficulty, and emotionality of their saddest memories, depressed individuals' happiest memories were less specific, harder to retrieve, and less emotional than were nondepressed participants' happiest memories. The memory characteristics of formerly depressed participants largely resembled those of healthy controls. Overall, the present results suggest that meaningful cues trigger mood-congruent memory processing in currently, but not in formerly, depressed individuals.     

Childhood trauma is linked to abnormal static-dynamic brain topology in adolescents with major depressive disorder

Childhood trauma is a leading risk factor for adolescents developing major depressive disorder (MDD); however, the underlying neuroimaging mechanisms remain unclear. This study aimed to investigate the association among childhood trauma, MDD and brain dysfunctions by combining static and dynamic brain network models. We recruited 46 first-episode drug-naïve adolescent MDD patients with childhood trauma (MDD-CT), 53 MDD patients without childhood trauma (MDD-nCT), and 90 healthy controls (HCs) for resting-state functional magnetic resonance imaging (fMRI) scans; all participants were aged 13–18 years. Compared to the HCs and MDD-nCT groups, the MDD-CT group exhibited significantly higher global and local efficiency in static brain networks and significantly higher temporal correlation coefficients in dynamic brain network models at the whole-brain level, and altered the local efficiency of default mode network (DMN) and temporal correlation coefficients of DMN, salience (SAN), and attention (ATN) networks at the local perspective. Correlation analysis indicated that altered brain network features and clinical symptoms, childhood trauma, and particularly emotional neglect were highly correlated in adolescents with MDD. This study may provide new evidence for the dysconnectivity hypothesis regarding the associations between childhood trauma and MDD in adolescents from the perspectives of both static and dynamic brain topology.     

Perfectionism and depression symptom severity in major depressive disorder.

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.     

Differences in smoking attitudes of adolescents and young adults

This study employed the Theory of Planned Behavior to examine the differences between adolescent (n = 182) and young adults (n = 209) in their intention to smoke and examined possible differences. Analysis showed that young adults had more positive self-reported attitudes toward smoking than adolescents, had higher intentions to smoke, lower perceived behavioral control over smoking and perceived they were more informed about smoking. The Theory of Planned Behavior provided good prediction of intention for both young adults (R2 = .70, attitudes, information, and past behavior significant) and adolescents (R2 = .68, attitudes, past behavior significant). For both samples attitudes were the strongest predictor of intentions to smoke. Implications for understanding intention toward smoking between adolescents and young adults are discussed.