Comorbidity of Anxiety and Depression in Children and Adolescents: An Integrative Review

Much evidence exists documenting the comorbidity of anxiety and affective disorders in youth. Furthermore, comorbidity appears to have serious implications both in terms of severity of impairment and course of disorder. Despite this, little is known about the meaning behind the high rate of co-occurrence of anxiety and depression in children and adolescents. Several conditions exist that may give rise to comorbidity. Specifically, two disorders may be comorbid when there is a high rate of symptom overlap between the disorders, when one underlying construct is split into two separate disorders, when the disorders share common risk or etiological factors, or because one disorder causes or increases the risk of developing the second disorder. The present paper examines each of these explanations as they relate to the comorbidity of anxiety and depression in youth.     

ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.     

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n?=?3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

     

The Developmental Origins and Treatment Needs of Female Adolescents With Depression

Rates of female to male depression rapidly soar during adolescence to a 2:1 ratio despite fairly equal rates throughout childhood. The literature suggests that changes in social development, social role expectations, and/or biology may play significant roles, but research considering these factors is scarce and inconsistent. This review considers how current information about these factors can help develop more culturally and client‐appropriate treatment approaches and guide recommendations for the next steps in research.     

Behavioral Genetics as a Tool for Developmental Psychology: Anxiety and Depression in Children and Adolescents

Over the past decade there has been a huge increase in the number of behavioral genetic studies looking into anxiety and depression in children and adolescents. There are now enough data in this area to make a review of the results useful. This paper begins with an outline of the methods used in such research and moves on to review the results in extant studies. Overall, these studies indicate modest to moderate genetic influence on both anxiety and depression. However, behavioral genetic methods are also paramount for exploring environmental influences in addition to genetic influences. Shared environment (that which makes family members resemble one another) is rarely identified in adult studies of personality or psychopathology and does not appear to be a significant influence for depression but it is for anxiety. Nonshared environment, which makes family members differ from one another, is found to be a significant influence for both anxiety and depression. Patterns within these results due to rater effects, age effects, sex effects, the precise phenotype measured, and the study design are explored.     

Neural Correlates of Reward Processing in Adolescents With a History of Inhibited Temperament

ABSTRACT— Functional imaging data were acquired during performance of a reward-contingency task in a unique cohort of adolescents (ages 14–18 years) who were characterized since infancy on measures of temperamental behavioral inhibition. Neural activation was examined in striatal structures (nucleus accumbens, putamen, caudate) with a known role in facilitating response to salient reward-related cues. Adolescents with a history of behavioral inhibition, relative to noninhibited adolescents, showed increased activation in the nucleus accumbens when they believed their selection of an action would affect reward outcome. Neural responses did not differ between the two groups when participants made a prespecified response that they knew would result in reward or when they produced random motor responses that they knew would not be rewarded. These results link inhibited temperament and perturbed neural responses to reward-contingency cues.     

注意瞬脱神经机制的研究

在很短的时间间隔内连续呈现两个目标刺激时,被试对第二个目标刺激的正确报告率显著下降,这种现象就是注意瞬脱.该文简述了注意瞬脱的概念、容量有限性等方面,尤其详细介绍了注意瞬脱神经机制研究的新进展,并对今后的研究提出展望.     

Adolescents in Wartime US Military Families: A Developmental Perspective on Challenges and Resources

Adolescents in wartime US military families are a unique group of young people who are experiencing the usual milestones of adolescent development, including establishing their identities and becoming autonomous, while they face the challenges of military life such as multiple frequent moves, relocation, and parent deployment to combat settings. This paper reviews research on adolescents in wartime US military families, within the context of adolescent development, to identify their behavioral, emotional and academic risk status, and challenges and resources. Recommendations for future research and interventions to foster the healthy development of these adolescents are also provided.     

Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety

Comorbidity in clinical youth populations is more the rule than the exception, yet few established guidelines exist to help practicing clinicians manage complex diagnostic profiles. The current paper reviews efforts within the treatment development literature to handle comorbidity in depressed and anxious children and adolescents, including single-target, modular-based, and transdiagnostic interventions. Two case studies are presented to describe how comorbid anxiety and depression are managed within two different evidence-based single-target interventions. A third case is presented to introduce a novel individual behavioral activation therapy (IBAT) designed to address co-occurring depression and anxiety by targeting a single maintaining mechanism (avoidance) that underlies both disorders. Implications for clinical decision-making (assessing complex clinical profiles in practice, prioritizing treatment goals, selecting interventions from a broad evidence base) are discussed.     

Concurrent Treatment of Depression in Parents and Adolescents: A Case Example

The detrimental influence of parent psychopathology—and depression, in particular—on adolescent mental health has been well documented. Routes of transmission include both direct and indirect factors, such as poor parent–adolescent communication, ineffective parenting practices, modeling ineffective coping skills, increased family discord and stress, inadvertent reinforcement of adolescent depressed mood and suicidal ideation and behavior, and decreased treatment adherence. This paper introduces a novel treatment to concurrently treat both a depressed adolescent as well as a depressed parent. This approach improves upon traditional cognitive-behavioral therapy by targeting relational factors of each adolescent–parent dyad while simultaneously addressing each individual’s depression. Principles of case conceptualization and treatment planning using this novel approach are illustrated using a case example.     

Learning Disabilities and Delinquent Behaviors among Adolescents: A Comparison of Those with and without Comorbidity

Research is inconclusive on whether adolescents with learning disabilities (LD) engage in more delinquency than adolescents without such deficits. Mixed results may result from a failure to account for the effects of co-occurring disabilities. Using the National Longitudinal Study of Adolescent Health, this study examines delinquency among adolescents without disabilities to youth with LD, Attention Disorder Symptoms (ADS), and comorbid LD/ADS. Results indicate no significant differences in property offenses, or alcohol, tobacco, and marijuana use; however, youth with LD reported significantly more violence than non-disabled youth. Findings illustrate the heterogeneous effects various disabilities have on delinquent behavior. Future research and policy implications will be discussed.     

英国青少年科学创造力的发展研究

对英国6所学校11岁到15岁的1087名中学生的科学创造力进行了研究,结果表明：英国青少年科学创造力及其各成分的发展存在着显著的年龄差异,随着年龄的增大,科学创造力及其各成分呈持续发展趋势,但在14岁时要下降;第二,英国青少年的科学创造力存在明显的性别差异。总的来讲,女生优于男生。但就科学创造力的各个成分来看,男女生具有不同的特点。     

Cognitive Theories of Depression in Children and Adolescents: A Conceptual and Quantitative Review

This paper quantitatively reviews longitudinal studies examining three central cognitive theories of depression—Beck’s theory, Hopelessness theory, and the Response Styles theory—among children (age 8–12) and adolescents (age 13–19). We examine the effect sizes in 20 longitudinal studies, which investigated the relation between the cognitive vulnerability–stress interaction and its association with prospective elevations in depression after controlling for initial levels of depressive symptoms. The results of this review suggest that across theories there is a small relation between the vulnerability–stress interaction and elevations in depression among children (pr = 0.15) and a moderately larger effect (pr = 0.22) among adolescents. Despite these important findings, understanding their implications has been obscured by critical methodological, statistical, and theoretical limitations that bear on cognitive theories of depression. The evidence base has been limited by poor measurement of cognitive vulnerabilities and over reliance on null hypothesis significance testing; these have contributed to a field with many gaps and inconsistencies. The relative paucity of research on developmental applications of such theories reveals that surprisingly little is known about their hypothesized etiologic mechanisms in children and adolescents. Ways to advance knowledge in the area of cognitive theories of depression among youth are discussed.     

Assessment of Depression in Adolescents: Objective and Projective Measures

This study is a multimethod assessment of depressive features in a sample of 60 adolescent inpatients. The purpose of the study was to examine the relationship between self-report measures of depression and Rorschach variables commonly associated with depression. Patients represented a variety of diagnostic categories in order to determine whether information gathered through assessment instruments was related to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III], American Psychiatric Association, 1980) diagnoses of depression. Findings indicated that this sample of adolescents was highly defensive and emotionally constricted. There were several significant relationships between self-report measures and Rorschach indicators of depression. However, in general, the Rorschach variables were not strongly related to depression. The self-report measures were more accurate than Rorschach variables in discriminating between depressed and nondepressed subjects.     

Developmental Potential in Venezuelan and American Artists: A Cross-Cultural Validity Study

By comparing the overexcitability scores of 27 Venezuelan and 23 American artists, support was found for the hypothesis that creative individuals show a high degree of animistic, intuitive, and emotional thinking. Overexcitability refers to heightened mental functioning in Dabrowski's (1964) theory of emotional development. Along with other special talents and abilities, it represents the developmental potential for intensified personality growth. Scores on 4 of the 5 dimensions of overexcitability were not significantly different for American and Venezuelan artists. This evidence of similar profiles for artists in 2 different societies demonstrates cross-cultural validity for the concept of developmental potential.     

Loss Of Trust: Correlates Of The Comorbidity Of Ptsd and Severe Mental Illness

Abstract

The prevalence of post-traumatic stress disorder (PTSD) in the general population of the United States is a topic of speculation, with estimates ranging from 0.4% to 9% (Breslau, Davis, Andreski, & Peterson, 1991; Helzer, Robins, & McEvoy, 1987; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Likewise, estimates of the prevalence of PTSD within the population of persons with serious mental illness have varied widely, depending on how PTSD has been measured. While record verification of PTSD within mental health outpatient samples has routinely been very low (0%-3%), research assessments of PTSD have resulted in estimated rates of co-occurrence of 29% to 43% (Cascardi, Mueser, DeGirolomo, & Murrin, 1996; Craine, Henson, Colliver, & MacLean, 1998; Mueser et al., 1998). A lack of documentation of PTSD in clinical records and inattention to PTSD in clinical diagnoses are thought to greatly underestimate the extent of PTSD within mental health treatment populations. The general consensus among researchers has been that the occurrence of PTSD is much higher within the population of persons with diagnoses of mental illness than in the general population, particularly among those who have major depression (Friedman & Rosenheck, 1996).     

Anxiety and Depression in Children and Adolescents: A Factor-Analytic Examination of the Tripartite Model

The tripartite model of Clark and Watson (1981) suggests that the oft-observed covariation between anxiety and depression can best be understood by examining three related yet distinct constructs: negative affectivity, positive affectivity, and elevated physiological arousal. In the present study, 510 boys and girls in the 4th, 7th, and 10th grades completed the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Confirmatory factor analyses were conducted to determine the goodness of fit of single-factor (i.e., negative affectivity), two-factor (i.e., anxiety and depression), and three-factor models (i.e., negative affectivity, positive affectivity, and physiological arousal). Analyses were conducted by examining each of the models in the whole sample first and then separately for boys and girls and for fourth, seventh, and tenth grade youths. Results failed to support the tripartite theory; rather, the findings supported a two-factor model in all cases. These factors represented the general constructs of anxiety and depression, and these factors remained significantly interrelated. Consistent with previous findings, the strength of these relations was stronger for boys than girls and for children than adolescents.     

The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence

An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment, and prognosis. Four main hypotheses have been put forth to account for these high rates of comorbidity. First, comorbidity may be a result of shortcomings associated with referral or informant biases. Second, comorbidity may be an artifact of overlapping definitional criteria. Third, one disorder may cause the other disorder by influencing the developmental trajectory and placing an individual at increased risk for further difficulties. Finally, comorbidity between two disorders may be explained by shared underlying causal or risk factors. The purpose of this review is to explore these possibilities, concentrating primarily on the common risk factors of parent psychopathology, emotion regulation, and cognitive biases that may underlie the co-occurrence of these two disorders. Based on our review, we propose a model for the development of comorbidity between these two disorders.