Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.     

Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic

The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.     

Emergence of attributional style and its relation to depressive symptoms

The development of depressive attributional style (AS) and its role as a cognitive diathesis for depression were examined in children and adolescents (Grades 2-9). In a 4-wave longitudinal study of 3 overlapping age cohorts, AS, negative life events, and depressive symptoms were evaluated every 12 months. Consistency of children's attributions across situations was moderately high at all ages. The cross-sectional structure of AS changed with age, as stability became a more salient aspect of AS than internality and globality. The structure of AS also changed, becoming more traitlike as children grew older. In longitudinal analyses, evidence of a Cognitive Diathesis x Stress interaction did not emerge until Grades 8 and 9, suggesting that AS may not serve as a diathesis for depression at younger ages. Results suggest that attributional models of depression may require modification before they are applied across developmental levels.     

Comorbid social anxiety disorder in clients with depressive disorders: predicting changes in depressive symptoms, therapeutic relationships, and focus of attention in group treatment

The current study examined whether depressed outpatients with comorbid SAD respond differently to a cognitive-behavioral group intervention and if so, how and why. Using growth curve modeling, we found evidence that depressed clients with comorbid SAD had rapid improvement in depressive symptoms over the course of treatment and generally did not differ from those without comorbidity in developing close therapeutic relationships and modifying the direction of attentional focus away from the self. Non-linear effects demonstrated that rates of change in depressive symptoms, relationship variables, and focus of attention, were most rapid early in treatment. In contrast to hypotheses, trajectories of change in therapeutic relationships and attentional focus did not mediate the effect of SAD on treatment improvement in depressive symptoms. These findings suggest that comorbid SAD does not have a detrimental effect on the course of depression treatment and group-based treatments can be as beneficial for depressed individuals with comorbid SAD. It may be that group-based treatments for depression provide explicit opportunity for emotional processing in social situations (i.e., exposure) and hence mimic efficacious therapies for SAD.     

Caregiver Attributions for Late‐Life Depression and Their Associations with Caregiver Burden

Late‐life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person‐centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression‐specific burden. Intention attributions were significantly associated with general burden, but not depression‐specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.     

A longitudinal study of children's depressive symptoms, self-perceptions, and cognitive distortions about the self

This longitudinal study examined how depressive symptoms relate to children's self-perceptions and to estimates of children's cognitive distortions about the self in a nonclinical sample of children who were followed from 4th grade (n = 248) through 6th grade (n = 227). Report card grades measured children's academic competence, and teachers' ratings of children's level of peer acceptance at school indicated social acceptance. Self-reported depressive symptoms predicted a change in children's negative views of the self. Moreover, the self-perceptions of children who exhibited more symptoms of depression appeared to reflect an underestimation of their actual competence. Children's negative self-perceptions and underestimations about the self were not associated with a subsequent change in depressive symptoms. The implications of the findings for cognitive theories of depression and future research with this population are discussed.     

Group Cognitive Behavior Therapy for Chronic Posttraumatic Stress Disorder: An Initial Randomized Pilot Study

Individuals with posttraumatic stress disorder (PTSD) related to a serious motor vehicle accident were randomly assigned to either group cognitive behavioral treatment (GCBT) or a minimum contact comparison group (MCC). Compared to the MCC participants (n = 16), individuals who completed GCBT (n = 17) showed significant reductions in PTSD symptoms, whether assessed using clinical interview or a self-report measure. Among treatment completers, 88.3% of GCBT participants did not satisfy criteria for PTSD at posttreatment assessment, relative to 31.3% of the MCC participants. Examination of anxiety, depression, and pain measures did not show a unique advantage of GCBT. Treatment-related gains were maintained over a 3-month follow-up interval. Patients reported satisfaction with GCBT, and attrition from this treatment was comparable with individually administered CBTs. Results are discussed in light of modifications necessitated by the group treatment format, with suggestions for future study of this group intervention.     

Predictors and consequences of childhood depressive symptoms: a 5-year longitudinal study.

A 5-year longitudinal study investigated the interrelationships among children's experiences of depressive symptoms, negative life events, explanatory style, and helplessness behaviors in social and achievement situations. The results revealed that early in childhood, negative events, but not explanatory style, predicted depressive symptoms; later in childhood, a pessimistic explanatory style emerged as a significant predictor of depressive symptoms, alone and in conjunction with negative events. When children suffered periods of depression, their explanatory styles not only deteriorated but remained pessimistic even after their depression subsided, presumably putting them at risk for future episodes of depression. Some children seem repeatedly prone to depressive symptoms over periods of at least 2 years. Depressed children consistently showed helpless behaviors in social and achievement settings.     

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.     

Validity of Adolescent and Parent Reports on the Six-Item ADHD Self-Report Scale (ASRS-6) in Clinical Assessments of Adolescent Social Anxiety

Adolescents experiencing social anxiety often experience co-occurring attention-deficit/hyperactivity disorder (ADHD) symptoms. Yet, assessing for social anxiety poses challenges given the already time-consuming task of distinguishing social anxiety from other commonly co-occurring internalizing conditions (e.g., generalized anxiety, major depression). Assessors need short screening devices to identify socially anxious adolescents in need of intensive ADHD assessments. A six-item version of the ADHD Self-Report Scale (ASRS-6) was originally developed to identify adults who likely meet diagnostic criteria for ADHD, but its psychometric properties have yet to be examined among adolescents. We tested the psychometric properties of the ASRS-6 when administered in clinical assessments for adolescent social anxiety. Eighty-nine 14–15 year old adolescents and their parents (67.4% female; 62.1% African American; 30 Clinic-Referred; 59 Community Control) completed the ASRS-6, measures of adolescent social anxiety and depressive symptoms, and parent-adolescent conflict. Adolescent self-reported and parent-reported ASRS-6 positively related with scores from established measures of social anxiety, depressive symptoms, and parent-adolescent conflict. Further, adolescent self-reported (but not parent-reported) ASRS-6 scores significantly discriminated adolescents on referral status. Adolescent self-reported (but not parent-reported) ASRS-6 scores incrementally predicted social anxiety over-and-above depressive symptoms, which commonly co-occur with social anxiety. Conversely, parent-reported (but not adolescent self-reported) ASRS-6 scores incrementally predicted parent-adolescent conflict over-and-above depressive symptoms, which commonly co-occur with conflict. When assessing adolescent ADHD symptoms, adolescents’ and parents’ reports meaningfully vary in their links to validity indicators. As such, among adolescents assessed for social anxiety, clinical assessments of adolescent ADHD symptoms should include both parent reports and adolescent self-reports.     

Parent and Adolescent Depressive Symptoms: The Role of Parental Attributions

This study examined whether negative parental attributions for adolescent behaviour mediate the association between parental and adolescent depressive symptoms, and whether this relationship is moderated by adolescent gender. Mothers and fathers and 124 adolescents (76 girls and 48 boys; ages 14 to 18) participated. Adolescents were primarily Caucasian, and varied in the level of depressive symptoms (with 27% of the sample meeting diagnostic criteria for a current unipolar depressive disorder). Parents and adolescents completed measures of depressive symptoms, and participated in a videotaped problem-solving discussion. After the discussion, each parent watched the videotape and, at 20 s intervals, offered attributions for their adolescent’s behaviour. Adolescent gender moderated the relation between parental attributions and adolescent depressive symptoms, with stronger associations for female adolescents. For both mothers and fathers, both parental depressive symptoms and negative attributions about the adolescent’s behaviour made unique contributions to the prediction of depressive symptoms in adolescent females. There also was evidence that negative attributions partially mediated the link between depressive symptoms in mothers and adolescent daughters. The results are interpreted as consistent with parenting as a partial mediator between parental and adolescent depressive symptoms, and suggest that adolescent girls may be particularly sensitive to parents’ negative interpretations of their behaviour.     

Indirect pathways between depressive symptoms and marital distress: the role of conflict communication, attributions, and attachment style

Previous studies have focused on concomitants of depression and marital distress in order to help explain the relationship between the two, suggesting that several variables, such as conflict communication, attributions, and attachment style, are associated with depression, marital distress, or both. Our contention is that the selected variables may be important mediators (hypothesis 1) or moderators (hypothesis 2) of the concomitance between depression and marital adjustment, exploring the direct and indirect ways in which depressive symptoms and marital adjustment are related. In total, 415 heterosexual couples were recruited, and a series of regression analyses was conducted to test our hypotheses separately for men and women. Results indicated that demand-withdrawal, avoidance, causal attributions, and secure, ambivalent, and avoidant attachment mediated the relation between depressive symptoms and marital adjustment in the female sample, whereas constructive communication and causal and responsible attributions were significant mediators of men's levels of depressive symptoms and marital adjustment. In addition, avoidance and secure attachment moderated the association between depressive symptoms and marital adjustment in the female sample, and causal attributions were significant moderators of the association between depressive symptoms and marital adjustment for men. Several conclusions and implications for theory and future research are discussed.     

Chatbot-Delivered Psychotherapy for Adults With Depressive and Anxiety Symptoms: A Systematic Review and Meta-Regression

Although psychotherapy is a well-established treatment for depression and anxiety, chatbot-delivered psychotherapy is an emerging field that has yet to be explored in depth. This review aims to (a) examine the effectiveness of chatbot-delivered psychotherapy in improving depressive symptoms among adults with depression or anxiety, and (b) evaluate the preferred features for the design of chatbot-delivered psychotherapy. Eight electronic databases were searched for relevant randomized controlled trials. Meta-analysis and random effects meta-regression was conducted using Comprehensive Meta-Analysis 3.0 software. Overall effect was measured using Hedges’s g and determined using z statistics at significance level p < .05. Assessment of heterogeneity was done using χ² and I² tests. A meta-analysis of 11 trials revealed that chatbot-delivered psychotherapy significantly improved depressive symptoms (g = 0.54, 95% confidence interval [−0.66, −0.42], p < .001). Although no significant subgroup differences were detected, results revealed larger effect sizes for samples of clinically diagnosed anxiety or depression, chatbots with an embodiment, a combination of types of input and output formats, less than 10 sessions, problem-solving therapy, off-line platforms, and in different regions of the United States than their counterparts. Meta-regression did not identify significant covariates that had an impact on depressive symptoms. Chatbot-delivered psychotherapy can be adopted in health care institutions as an alternative treatment for depression and anxiety. More high-quality trials are warranted to confirm the effectiveness of chatbot-delivered psychotherapy on depressive symptoms.PROSPERO registration number: CRD42020153332.     

The Role of Socially Prescribed Perfectionism in the Link Between Perceived Racial Discrimination and African American Adolescents’ Depressive Symptoms

Research examining the social origins of perfectionism has focused on negative evaluative experiences in the family, with less attention to negative social evaluations in other contexts and situations relevant for African American adolescents. The experience of racial discrimination is common for African American youth, and may trigger maladaptive perfectionistic beliefs if the youth perceive that they do not meet others’ standards (socially prescribed perfectionism) or internalize discriminatory messages. Thus, the present study examined longitudinal associations among racial discrimination, socially prescribed perfectionism, and depressive symptoms among a community sample of urban and predominantly low income African American adolescents (n?=?492; 46.7 % female). In each of grades 7, 8 and 9, participants reported their experiences with racial discrimination, perfectionistic beliefs, and depressive symptoms. Analyses revealed that experiences with racial discrimination in grade 7 were associated with socially prescribed perfectionism in grade 8 which, in turn, was linked with depressive symptoms in grade 9. Results suggest that prospective associations between the experience of racial discrimination and depressive symptoms are due, in part, to increased socially prescribed perfectionism. Implications for interventions targeting depression in African American are discussed.     

Response styles among patients with minor depression and dysthymia in primary care

Ruminative responses to depression have predicted duration and severity of depressive symptoms. The authors examined how response styles change over the course of treatment for depression and as a function of type of treatment. They also examined the ability of response styles to predict treatment outcome and status at follow-up. Primary care patients (n = 96) with dysthymia or minor depression were randomly assigned to problem-solving therapy, paroxetine, or placebo. Patients' depressive symptoms and rumination, but not distraction, decreased over time. Pretreatment rumination and distraction were associated with more depressive symptoms at the conclusion of treatment; the latter finding was not consistent with the response style theory of depression. Results are discussed in terms of their implications for this theory.     

A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months

Although few prevention studies have been designed to investigate the course of prevention effects over time, it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up. Furthermore, previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect. The present randomized control group study with 301 8th-grade students examined the effects of a depression prevention program from baseline until 12-month follow-up. As expected, while positive intervention effects were found on girls’ depressive symptoms, no such effects were found on boys’ depressive symptoms. Further, the positive intervention effects on girls’ depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up, while depression symptoms in control-group girls increased from 6-month to 12-month follow-up. Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect. However, some limited evidence was found indicating that total knowledge (cognitive and social) might partially explain the effect but there was significant variability remaining to be explained.     

Predictors of the first onset of a major depressive episode and changes in depressive symptoms across adolescence: stress and negative cognitions

This 6-year longitudinal study examined stressors (e.g., interpersonal, achievement), negative cognitions (self-worth, attributions), and their interactions in the prediction of (a) the first onset of a major depressive episode (MDE), and (b) changes in depressive symptoms in adolescents who varied in risk for depression. The sample included 240 adolescents who were first evaluated in Grade 6 (M = 11.86 years old; SD = 0.57; 54.2% female) and then again annually through Grade 12. Stressful life events and depressive diagnoses were assessed with interviews; negative cognitions and depressive symptoms were assessed with self-report questionnaires. Discrete time hazard modeling revealed a significant interaction between interpersonal stressors and negative cognitions, indicating that first onset of an MDE was predicted by high negative cognitions in the context of low interpersonal stress, and by high levels of interpersonal stressors at both high and low levels of negative cognitions. Analyses of achievement stressors indicated significant main effects of stress, negative cognitions, and risk in the prediction of an MDE, but no interactions. With regard to the prediction of depressive symptoms, multilevel modeling revealed a significant interaction between interpersonal stressors and negative cognitions such that among adolescents with more negative cognitions, higher levels of interpersonal stress predicted higher levels of depressive symptoms, whereas at low levels of negative cognitions, the relation between interpersonal stressors and depression was not significant. Risk (i.e., maternal depression history) and sex did not further moderate these interactions. Implications for intervention are discussed.     

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.     

Depression and Self-Esteem in Boys with Attention-Deficit/Hyperactivity Disorder: Associations with Comorbid Aggression and Explanatory Attributional Mechanisms

It was tested whether boys with attention-deficit/hyperactivity disorder (ADHD), subgrouped by aggressive status, would show higher rates of depressive symptomatology and lower levels of self-esteem than would comparison boys and, in a subsample, explored attributional mechanisms that may be related to such internalizing features. Study 1 utilized 114 boys with ADHD (all prior recipients of stimulant medication) and 87 comparison boys, aged 7–12 years. Aggressive boys with ADHD reported more symptoms of depression than did nonaggressive boys with ADHD, who, in turn, reported more depression than did comparison boys. Effect sizes were moderate to large and did not vary with a depression rating scale uncontaminated by ADHD-related items. For self-esteem, the most pronounced effect was that aggressive boys with ADHD showed lower levels than did nonaggressive ADHD or comparison boys; effects were again moderate to large. Study 2 participants were a subsample of boys with ADHD from Study 1 (N = 27). We probed causal attributions in ADHD-related domains through responses to hypothetical vignettes, in which the protagonist's medication status (medicated, not medicated) was crossed with type of outcome (good, bad). Medication-related attributions were frequent. In describing the protagonist's success in relation to medication treatment, the sample showed significant associations between (a) medication-related attributions and (b) increased depressive symptomatology as well as decreased self-esteem. We discuss attributional processes that may help to explain the variation in internalizing symptoms among children with ADHD.     

Depression and attributions in children and adolescents: A meta-analytic review

This article presents a meta-analytic review of the association between attributional styles and depressive symptoms in children and adolescents. In 28 studies involving 7500 subjects, the correlations were consistent with those predicted by the reformulated learned helplessness model of depression. For negative outcomes, attributions along the internal, stable, and global dimensions were associated positively with depression. Conversely, higher levels of depressive symptoms were related to more external, unstable, and specific attributions for positive events. Additionally, overall composite maladaptive attributional patterns for positive and negative events were correlated with higher levels of depressive symptoms in youth. Effect sizes for these associations ranged from moderate to large (Cohen, 1977). Findings from the significance tests of the combined results support the theory. A large number of unretrieved studies revealing null effects would be needed to invalidate these findings.