Cognitive and Interpersonal Vulnerabilities to Adolescent Depression: Classification of Risk Profiles for a Personalized Prevention Approach

Despite interest in psychosocial vulnerabilities to depression, little is known about reliable and valid individualized risk profiles that can be used to match individuals to evidence-based interventions for depression. This study investigated well-established cognitive and interpersonal vulnerabilities to depression among youth to discern an evidence-based risk classification approach which is being used in a personalized depression prevention randomized clinical trial. Data were drawn from a general community sample of adolescents (N?=?467; ages 10–16, mean 13.14, SD?=?1.62; 57% females) who were followed prospectively for 3 years. Youth completed measures of cognitive (negative cognitive style, dysfunctional attitudes, rumination) and interpersonal (support and conflict with peers and parents, excessive reassurance seeking, social competence, co-rumination) risks to depression, and then were followed longitudinally for onset of depression. Principal axis factor analyses showed that three latent factors--cognitive vulnerability, interpersonal support, and interpersonal conflict--optimally represented the structure of these risk factors. Clinically practical and meaningful cutoffs, based on tertile cut-off scores on cognitive and interpersonal risk measures, were used to categorize youth into relatively balanced high and low cognitive and interpersonal risk groups. These risk classification groups exhibited validity (AUC?>?0.70) by predicting prospective onsets of depressive episodes at 18-months follow-ups. These findings demonstrate a reliable and valid approach to synthesize psychosocial vulnerabilities to depression, specifically cognitive and interpersonal risks. Results are discussed in terms of using these risk classifications profiles to test personalized prevention of depression during adolescence.     

Identifying Cognitive and Interpersonal Predictors of Adolescent Depression

Emerging research has begun to examine cognitive and interpersonal predictors of stress and subsequent depression in adolescents. This research is critical as cognitive and interpersonal vulnerability factors likely shape expectations, perspectives, and interpretations of a given situation prior to the onset of a stressor. In the current study, adolescents (n?=?157; boys=64, girls=93), ages 12 to 18, participated in a 6-month, multi-wave longitudinal study examining the impact of negative cognitive style, self-criticism, and dependency on stress and depression. Results of time-lagged, idiographic multilevel analyses indicate that depressogenic attributional styles (i.e., composite score and weakest link approach) and self-criticism predict dependent interpersonal, but not noninterpersonal stress. Moreover, the occurrence of stress mediates the relationship between cognitive vulnerability and depressive symptoms over time. At the same time, self-criticism predicts above and beyond depressogenic attributional styles (i.e., composite and weakest link approach). In contrast to our hypotheses, dependency does not contribute to the occurrence of stress, and additionally, no gender differences emerge. Taken together, the findings suggest that self-criticism may be a particularly damaging vulnerability factor in adolescence, and moreover, it may warrant greater attention in the context of psychotherapeutic interventions.     

Adolescent Depression: Stressful Interpersonal Contexts and Risk for Recurrence

ABSTRACT— High rates of diagnosable depression in adolescence, especially among young women, present challenging clinical and research issues. Depression not only portends current maladjustment but may also signal risk for recurrent or chronic depression and its associated impairment. Because depression is most often a response to stressful events and circumstances, it is important to understand the stress context itself. Individuals with depression histories are known to contribute to the occurrence of interpersonal and other stressors at a high rate, and for young women particularly, the occurrence of interpersonal stressors and conditions in turn predicts recurrences of depression, in a vicious cycle. Interpersonal dysfunction in early adolescence predicts the likelihood of continuing maladaptive functioning in peer, family, romantic, and parenting roles. The transmission of depression from one generation to the next involves not only heritable factors but also the likelihood that depressed youth become caught in life contexts of marital and parenting discord that portend dysfunction for their offspring and continuing depression for themselves.     

青少年抑郁症后父母认知行为改变的质性研究

基于质性研究方法,对青少年患抑郁症后父母认知行为改变、当前家庭面临的困境进行研究。采用半结构式访谈法对18名青少年抑郁症患者的父亲/母亲进行深度访谈,运用Colaizzi七步分析法对访谈数据进行分析。研究结果揭示,青少年被诊断抑郁症后,尽管父母会反思与青少年抑郁症相关的家庭因素并发生相应的认知行为改变,但青少年家庭依然面临内外部困境,应发挥家庭、学校、社区、医院四方疾病管理体系的协同作用,为青少年抑郁症患者及其家庭提供长期支持,促进青少年治疗和社会功能恢复。

     

Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment—individual CBT for the child and behavioral parent training involving the caregiver and caregiver–child dyad. The effects were generally promising and illustrate how selection of inclusion criteria, measures, measurement intervals, and informants can alter conclusions. These areas warrant attention in studies of child depression and are important not only in interpreting treatment outcome data but also for conducting sound clinical practice.     

Negative Life Events and Substance Use Moderate Cognitive Behavioral Adolescent Depression Prevention Intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

The Default Mode Network and Recurrent Depression: A Neurobiological Model of Cognitive Risk Factors

A neurobiological account of cognitive vulnerability for recurrent depression is presented based on recent developments of resting state neural networks. We propose that alterations in the interplay between task positive (TP) and task negative (TN) elements of the Default Mode Network (DMN) act as a neurobiological risk factor for recurrent depression mediated by cognitive mechanisms. In the framework, depression is characterized by an imbalance between TN-TP components leading to an overpowering of TP by TN activity. The TN-TP imbalance is associated with a dysfunctional internally-focused cognitive style as well as a failure to attenuate TN activity in the transition from rest to task. Thus we propose the TN-TP imbalance as overarching neural mechanism involved in crucial cognitive risk factors for recurrent depression, namely rumination, impaired attentional control, and cognitive reactivity. During remission the TN-TP imbalance persists predisposing to vulnerability of recurrent depression. Empirical data to support this model is reviewed. Finally, we specify how this framework can guide future research efforts.     

Screening and Assessing Adolescent Substance Abuse: A Primer for Counselors

Adolescent substance abuse is an increasing problem in US. society. This article provides an overview of adolescent substance abuse, screening, and assessment strategies; contact information related to specific assessment instruments; and information regarding ethics important to consider during the assessment process.     

抑郁症的计算机化认知行为治疗

计算机化认知行为治疗(computerized cognitive-behavioral therapy, CCBT), 即指通过电脑交互界面, 以清晰的操作步骤, 高度结构化的多种媒介互动方式(如网页、漫画、动画、视频、声音等)来表现认知行为治疗基本原则和方法的治疗方式。抑郁症的CCBT近年来在西方崭露头角, 目前Beating The Blues、MoodGYM、E-Couch和Good Days Ahead等抑郁症CCBT程序在西方使用较为广泛。从可行性分析上发现, 该疗法较受病人接纳、具有较高的成本效用和易用性; 现有实验研究证明了抑郁症采用CCBT是有效的, 但其有效性仍取决于诸多因素。以往研究存在着较少关注治疗有效性的内在机制、治疗效果差异较大、风险评估简化和被试选择偏向等问题, 建议未来研究应加强：(1)中介效应及机制研究; (2)以人为本的个性化服务研究; (3)风险评估与隐私保护研究; (4)在“弱势群体”中的研究与运用。最后, 对其在中国发展的必要性与可行性进行了展望。     

Effect of Parenting and Peer Stressors on Cognitive Vulnerability and Risk for Depression among Youth

Parenting behaviors influence clinical depression among youth, but little is known about the developmental processes that may account for this association. This study investigated whether parenting is associated with the onset of clinical depression and depressive symptoms through negative cognitive style, particularly under conditions of high exposure to stressors, in a community sample of children and adolescents (N = 275; 59% girls). Observational methods were used to assess positive and negative parenting during a laboratory social-evaluative stressor task. Depressive symptoms and clinical depressive episodes were repeatedly assessed over an 18-month prospective follow-up period. Results supported a conditional indirect effect in which low levels of observed positive parenting during a youth stressor task were indirectly associated with an increased likelihood of experiencing an episode of depression and worsening depressive symptoms over the course of the study through youth negative cognitive style, but only for youth who also experienced a high number of peer stressors. These findings elucidate mechanisms through which problematic parenting may contribute to risk for the development of clinical depression during the transition into and across adolescence. Implications for depression interventions are discussed.     

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.     

DBT-Enhanced Cognitive Behavioral Therapy for Adolescent Trichotillomania: An Adolescent Case Study

Results and a case study for a DBT-enhanced habit reversal treatment (HRT) for adult trichotillomania (TTM) (Keuthen & Sprich, 2012) is adapted for use with adolescents. Trichotillomania in adolescence is a very important but understudied problem. Onset often occurs in adolescence, and yet very little treatment research exists. DBT-enhanced habit reversal has shown promise in adult samples (Keuthen et al., 2008) and may prove useful as a model for further study in adolescents. Here, we provide a case study using DBT-enhanced HRT with an adolescent girl. The treatment emphasizes traditional CBT for TTM and also includes a focus on emotion regulation, mindfulness, and distress tolerance to help manage both focused and automatic pulling.     

A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.     

Family Treatment Approaches for Depression in Adolescent Males

Adolescent depression is a serious and common disorder. Though adolescent males are less likely to report depression than females, they have serious risks associated with the disorder, like suicide, future substance abuse, and illegal activity. Several gender differences have been observed among depressed adolescents and should be considered in assessment and treatment. Little efficacy research exists for family treatments of depression in adolescent males, though several approaches have been proposed. These approaches include Structural Family Therapy, Interpersonal Family Therapy, and Attachment-Based Family Therapy. These treatments have been found useful in clinical settings, but much more efficacy research is necessary.     

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.