Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

青少年早期网络欺凌/受欺凌对睡眠质量的影响：社交焦虑和抑郁情绪的链式中介作用

基于压力认知失眠模型,采用网络欺凌/受欺凌问卷、青少年社交焦虑问卷、流调中心抑郁问卷和匹兹堡睡眠质量指数问卷,对582名中小学生进行三次追踪测查,每次间隔半年,并运用结构方程模型考察社交焦虑和抑郁情绪在网络欺凌/受欺凌对睡眠质量的影响的中介作用及其性别差异。结果表明：(1)社交焦虑和抑郁情绪在网络欺凌/受欺凌影响睡眠质量的路径中均起到链式中介作用;(2)网络欺凌/受欺凌影响睡眠质量的链式中介模型存在性别差异。这启示要改善网络欺凌者与受欺凌者的睡眠质量,应关注网络欺凌给他们带来的情绪困扰,只有从根本上解决其情绪问题,才能最终有效促进其睡眠质量。     

The Unified Protocols for Children and Adolescents in Partial Hospitalization: Using Implementation Science Frameworks to Guide Adaptation

Partial hospitalization programs (PHPs) and other acute mental health treatment programs, which are becoming increasingly common, may help divert children and adolescents from inpatient psychiatric care and provide a concentrated dose of intervention to individuals living in low-resource areas. However, there have been relatively few examinations of the effectiveness of PHPs in addressing emotional concerns (e.g., anxiety, depression, irritability) and functional impairment in youth. Further, evidence-based treatments originally designed for delivery in an outpatient weekly format may require significant adaptation to be appropriate for delivery in acute mental health settings, which differ significantly from weekly outpatient care in program structure, patient acuity, and staffing. In this intervention development and adaptation report, we present the rationale for adapting a transdiagnostic approach to treating emotional disorders—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A)—for a hospital-based, general psychiatric partial hospitalization program. We use implementation science frameworks to describe our iterative approach to treatment adaptation and testing and to describe in detail proactive, planned adaptations to the UP-C/A for partial hospitalization that occurred prior to initial implementation and pilot testing. Three case examples (child, preadolescent, adolescent) are presented to illustrate how a transdiagnostic approach to care such as the UP-C/A can be used intensively in an acute mental health setting to address emotional and behavioral concerns, including safety.     

父母教养行为与青少年早期抑郁的关系：多基因与负性生活事件的调节作用

以745名青少年为被试,采用多基因×多环境设计,考察COMT Val158Met、5-HTR1A C-1019G和BDNF Val66Met基因多态性的多基因累加得分与负性生活事件在父母教养行为与青少年早期抑郁之间的调节作用及其性别差异。结果发现,多基因累加得分与负性生活事件仅能显著调节父亲积极教养行为对青少年抑郁的预测作用,且该调节作用只存在于男青少年群体中。研究结果丰富了抑郁的多基因遗传机制研究,为制定青少年早期抑郁的干预措施提供了理论依据。     

Childhood Trauma Predicts Positive Expressive Suppression During Social Affiliation in Adults With Anxiety and/or Depression: Implications for Social Functioning

Experiencing childhood trauma (CT) can create barriers for developing relationships and is a risk factor for anxiety and depression. Expressive suppression (ES; i.e., reducing expression associated with experiencing emotions) might explain the link between CT and relationship formation difficulties. We examined the association between (1) CT and ES during a dyadic paradigm intended to facilitate connectedness between unacquainted partners and (2) ES and desire for future interaction (DFI). Individuals with an anxiety or depressive disorder diagnosis (N = 77) interacted with a trained confederate; partners answered a series of increasingly intimate questions about themselves. Participant ES for positive and negative emotions, and participant and confederate DFI were collected during the task. Participants completed global anxiety, depression, and CT measures. CT correlated with positive (r = .35, p = .002), but not negative, ES (r = .13, p = .273). In a multiple linear regression model, CT predicted positive ES beyond symptom variables and gender, β = .318, t = 2.59, p = .012. Positive ES correlated with participant (r = ?.38, p = .001) and confederate DFI (r = ?.40, p<.01); and predicted participant DFI beyond symptom variables and ethnicity, β = ?.358, t = ?3.18, p = .002, and confederate DFI, β = ?.390, t = ?3.51, p = .001, beyond symptom variables. Mediation analyses suggested positive ES accounted for the relationship between greater CT severity and less desire for future interaction from participants, 95%CI [?0.26, ?0.02], and confederates, [?0.38, ?0.01]. Positive ES may be an important factor in the reduced capacity to form new social relationships for individuals with a history of CT, anxiety, and depression.     

The Head,the Heart,and the Community: Piloting a Brief Home-Based Mindfulness Intervention for Couples With Low Income

Although mindfulness is documented to reduce both individual and relationship stress and has the flexibility to be taught anywhere (e.g., at home, clinic setting, etc.), research examining mindfulness interventions among individuals with low income and economic marginalization (LIEM; APA, 2019), or persons whose economic position negatively impacts their health or well-being due to factors such as access to healthcare, is limited. To address this gap, the author and colleagues used Community Based Participatory Research methods to develop a brief, couple-based, mindfulness intervention tailored for communities with LIEM (see Lenger et al., 2022). The present study tested this newly developed brief, couple-based, mindfulness intervention's effectiveness in improving individual and relationship health through 1- and 2-months post-intervention. The intervention was piloted on a sample of 39 couples with an overrepresentation of couples with LIEM. To improve access to care, couples could participate in their home or a variety of local clinics. Thirty-nine couples received the intervention and completed assessments on mindfulness, depression, anxiety, stress, relationship satisfaction, and communication at baseline, 1-month, and 2-months post-intervention. Results revealed that mindfulness, depression, and relationship satisfaction improved from baseline to 1-month post-intervention. Mindfulness improved at a greater rate for couples with LIEM relative to couples with higher incomes. From baseline to 2-months post-intervention, depression and stress significantly improved at similar rates for couples with higher income and couples with LIEM. Thus, this study indicates that mindfulness can be taught in a brief, two-session format, and can have favorable outcomes on individual and relationship functioning.     

Prenatal maternal depression predicts neural maturation and negative emotion in infants

Despite widespread acceptance that prenatal symptoms of depression in mothers are detrimental to infants’ long-term emotional and cognitive development, little is known about the mechanisms that may integrate outcomes across these domains. Rooted in the integrative perspective that emotional development is grounded in developing cognitive processes, we hypothesized that prenatal symptoms of depression in mothers would be associated with delays in neural maturation that support sociocognitive function in infants, leading to more problematic behaviors. We used a prospective longitudinal study of mothers (N = 92) and their infants to test whether self-reported symptoms of depression in mothers during the second and third trimesters were associated with neural development and infant outcomes at 4 months of age. While controlling for postpartum symptoms of depression, more prenatal symptoms of depression in mothers predicted less neural maturation in the parietal region of 4-month-old infants. Less neural maturation, in turn, was associated with greater infant negativity, suggesting neural maturation as a putative mechanism linking maternal symptoms of depression with infant outcomes. Differences in neural regions and developmental timing are also discussed.     

Medical or relational language? Problem and goal formulation in family therapy with adolescents conducted in a psychiatric outpatient setting

The constructionist view assumes that therapy participants' maps of understanding depend on the institutional context and their personal perspectives. The purpose of this study was to investigate the initial maps of difficulties reported by family members starting family therapy. 106 families that were referred to a psychiatric institution for outpatient family therapy were asked open-ended questions regarding the context of the referral, and goal and problem formulation for the therapy. The data were analysed via the consensual qualitative research-modified (CQR-M) method, and comparisons between groups were performed. The obtained results show a diversity of perspectives. Of interest was the predominance of medical language in describing the problem and relational language in describing the goal of therapy. An analysis of differences between mothers, fathers, adolescent patient and their siblings was also performed. The findings highlight the complexity of notions that families start family therapy with and may help therapists navigate through the therapeutic contract formulation process.     

The Coincidence of Depression and High Ability in Delinquent Youth

We describe the incidence and coincidence of depression and high ability in a sample of Virginia's incarcerated delinquent youth population. Specifically, 207 incarcerated juveniles were assessed with the Raven's Advanced Progressive Matrices and the Children's Depression Inventory (CDI). The data indicated there were as many high ability juveniles in detention settings as would be expected in a regular population. Results from the CDI identified 37% as at risk for clinical depression. Cross-tabulation of the data indicated a significant relationship between high ability and depression in the delinquent population. In addition, the findings indicated that the presence of depression is related to the ability level of the juvenile. That high ability delinquents may be more vulnerable to depression argues that the coincidence of these conditions requires consideration. Based upon these findings, and given the high correlation suicide has with depression, we suggest that screening for depression should be mandatory for incarcerated delinquents.