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Objective: Patients with epistemic mistrust struggle to view others as trustworthy sources of knowledge and often default to negative appraisals in social communication. The three communication systems theory posits that resolving epistemic mistrust involves three systems: the epistemic match, improving mentalizing, and the re-emergence of social learning outside therapy. This study aimed to empirically examine the theory to understand how epistemic trust develops in psychotherapy., Method: Using a theory-building case study approach, we analyzed therapeutic processes in six depressed adolescents ( M age = 16.58, SD = 1.17) with varying treatment outcomes. Sixty-six audiotaped psychotherapy sessions were reviewed to compare good- and poor-outcome cases, identifying patterns within therapeutic interactions., Results: Findings provide the first empirical evaluation of the three communication systems theory, offering concrete examples of how it unfolds in clinical practice and suggesting refinements in therapist and patient processes to build epistemic trust. Additional insights into the theory highlight an early "window of opportunity" to foster epistemic openness, the influence of environmental factors outside therapy, and the interactive nature of therapist-patient dynamics., Conclusion: This study refines the theoretical understanding of epistemic trust in psychotherapy, revealing specific therapist and patient behaviors that may facilitate its development. Implications for clinical practice and future research directions are discussed.

Adolescent depression is a globally concerned mental health issue, the pathophysiological mechanisms of which remain elusive. Membrane lipids play a crucial role in brain development and function, potentially serving as a crossroad for the abnormalities in neurotransmitters, neuroendocrine, inflammation, oxidative stress, and energy metabolism observed in depressed adolescents. The primary aim of this study was to investigate the erythrocyte membrane lipid profile in adolescent depression. A total of 2838 erythrocyte membrane lipids were detected and quantified in 81 adolescents with depression and 67 matched healthy adolescents using ultra-high performance liquid chromatography-mass spectrometry. Depressed adolescents exhibited significantly different membrane lipid characteristics compared to healthy controls. Specifically, the levels of cholesterol, sphingomyelins, and ceramides were increased, while ether lipids were decreased in patients. Moreover, the patients showed reduced polyunsaturated fatty acids and elevated lipophilic index in membrane, suggesting diminished membrane fluidity. The higher oxidized membrane lipids and plasma malondialdehyde were observed in adolescent depression, indicating the presence of oxidative stress. Importantly, membrane lipid damage was associated with more severe depressive symptoms and worse cognitive function in patients. In addition, reduced polyunsaturated fatty acids and membrane fluidity may be partly responsible for the blunted niacin skin flushing response found in depressed adolescents. In conclusion, our results reveal impaired erythrocyte membrane lipid homeostasis in adolescents with depression, which may implicate membrane dysfunction in the brain. These findings offer new insights into the underlying molecular mechanisms of adolescent depression, highlighting the potential of counteracting membrane damage as a promising avenue for future therapeutic interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Autonomy support (AS) and psychological control (PC) are important parenting behaviors in adolescence, with low AS and high PC relating to adolescent depression. Studies on observed levels of AS and PC in a clinical sample are lacking. The current study aimed to (1) develop a reliable coding system for parental AS and PC in parent-adolescent interactions and gain insights into its ecological validity in a healthy control (HC) sample, and (2) disentangle observed and adolescent-perceived parenting behaviors in relation to adolescent depression. HC adolescents (N = 80, M age  = 15.90, 63.7% girls, 91.3% White) and their parents (N = 148, M age  = 49.00, 53.4% female, 97.3% White) and adolescents with depression (current MDD/dysthymia; N = 35, M age  = 15.60, 77.1% girls, 65.7% White) and their parents (N = 62, M age  = 50.13, 56.5% female, 79.0% White) participated in three videotaped dyadic interaction tasks (problem solving, event planning, and reminiscence). Adolescents reported on their parents' behavior and their own positive and negative affect after each task, while observed AS and PC were coded from the videos. Multilevel analyses showed that observed AS and PC, coded with our reliable system, related to adolescent-perceived parenting (in daily life), confirming ecological validity. Adolescents with depression (vs. HC) had more negative perceptions of parenting, whereas observed AS and PC did not differ, indicating a negativity bias of adolescents with depression. Lastly, observed PC related to a lower affective state in adolescents with depression, but not HC. Parents could be psycho-educated on the impact of this behavior in a clinical setting., (© 2025 The Author(s). Journal of Research on Adolescence published by Wiley Periodicals LLC on behalf of Society for Research on Adolescence.)

This review examines neuroimaging studies on adolescent depression (AD) within the Research Domain Criteria (RDoC) framework, focusing on fMRI, DTI, and EEG findings. The research highlights disrupted connectivity in several neural networks-such as the affective, reward processing, cognitive control, and default mode networks-that underpin emotional and cognitive dysfunctions in AD. Notably, hypoconnectivity in the affective and cognitive control networks correlates with deficits in emotional processing and executive functioning, while hyperactivity in the default mode network relates to excessive self-referential thoughts. Additionally, blunted reward responses and frontal-striatal connectivity are discussed alongside the therapeutic potential of cognitive behavioral therapy (CBT) to modulate these dysfunctional circuits. Despite these insights, variability in findings due to small sample sizes and diverse methodologies suggests a need for further research to validate neuroimaging biomarkers for treatment efficacy and to explore less studied treatments like ECT and TMS in this population. This review underscores the importance of integrating neuroimaging findings to enhance understanding and treatment of AD., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest to report regarding this study., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Currently, adolescent depression is one of the most significant public health concerns, markedly influencing emotional, cognitive, and social maturation. Despite advancements in distinguish the neurobiological substrates underlying depression, the intricate patterns of disrupted brain network connectivity in adolescents warrant further exploration., Aim: To elucidate the neural correlates of adolescent depression by examining brain network connectivity using resting-state functional magnetic resonance imaging (rs-fMRI)., Methods: The study cohort comprised 74 depressed adolescents and 59 healthy controls aged 12 to 17 years. Participants underwent rs-fMRI to evaluate functional connectivity within and across critical brain networks, including the visual, default mode network (DMN), dorsal attention, salience, somatomotor, and frontoparietal control networks., Results: Analyses revealed pronounced functional disparities within key neural circuits among adolescents with depression. The results demonstrated existence of hemispheric asymmetries characterized by enhanced activity in the left visual network, which contrasted the diminished activity in the right hemisphere. The DMN facilitated increased activity within the left prefrontal cortex and reduced engagement in the right hemisphere, implicating disrupted self-referential and emotional processing mechanisms. Additionally, an overactive right dorsal attention network and a hypoactive salience network were identified, underscoring significant abnormalities in attentional and emotional regulation in adolescent depression., Conclusion: The findings from this study underscore distinct neural connectivity disruptions in adolescent depression, underscoring the critical role of specific neurobiological markers for precise early diagnosis of adolescent depression. The observed functional asymmetries and network-specific deviations elucidate the complex neurobiological architecture of adolescent depression, supporting the development of targeted therapeutic strategies., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

This study evaluated the role of bidirectional micro- and macro- level positive affect-related processes in the longitudinal coupling of depressive symptoms in parent-adolescent dyads. Using a measurement-burst design, including dyadic experience sampling methods (ESM) and monthly follow-ups over one year, this work investigated associations between (1) parental depressive symptoms and anhedonia and parental daily-life enhancing and dampening responses to youth positive affect; (2) parental daily-life enhancing and dampening and trajectories of youth positive affect, negative affect, and depressive symptoms across one year; and (3) youth developmental trajectories and prospective parental daily-life enhancing and dampening, and parental depressive symptoms and anhedonia at one-year follow-up. Participants included 146 early adolescents (52.1% girls, 47.9% boys; M age [SD] = 12.71[.86]) and 139 parents (78.7% mothers; M age [SD] = 44.11[5.08]). Parental enhancing and dampening were measured using a dyadic ESM procedure at baseline and 12-months. Youth completed monthtly questionnaires assessing depressive symptoms and trait positive and negative affect across 12 months. Parents reported on depressive symptoms and anhedonia at baseline and 12-months. Results showed that parental anhedonia negatively related to parental daily-life enhancing, and youths' perceptions of their parents' enhancing and dampening reciprocally related to youth emotional development across one year, with downstream implications for parents' own symptoms of depression.

Objective: To systematically evaluate the measurement properties of 12 patient-reported outcome measures (PROMs) used to measure depression symptom severity in adolescents with depression. Depression symptom severity was chosen as the outcome of focus given its importance as an outcome to measure in adolescents with depression across clinical trials and/or care., Method: MEDLINE, PsycInfo, Embase, Scopus, CINAHL, and Cochrane were searched from year of inception up to December 7, 2023. Study appraisal (ie, risk of bias), evaluation of measurement properties, and evidence synthesis followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Included studies evaluated at least 1 of 9 measurement properties as detailed in the COSMIN taxonomy within a reported sample or subgroup of youth ages 12 to 24 years, with at least 40% meeting criteria for any depressive disorder., Results: Of the 15,560 records identified, 31 studies for 7 PROMs were included in the COSMIN appraisal. Although several PROMs have the potential to accurately measure depression symptom severity in adolescents with depression, at this time none of the PROMs can be recommended for use without further evaluative work. High-quality evidence was generally lacking, largely due to few or inconsistent findings, small sample sizes, and other methodological concerns., Conclusion: This systematic review of the measurement properties of 12 PROMs used to measure depression symptom severity in adolescents with depression found that none of the PROMs can be recommended for use until further evaluative work is conducted. Clinicians and researchers should proceed with caution when using these PROMs., Plain Language Summary: This systematic review evaluated 12 patient report outcome measures (PROMs) commonly used to measure depression symptom severity in adolescents with depression. Only 7 of these PROMs had studies to evaluate; none of them had the necessary measurement properties to indicate that they could be recommended for use or that results could be trusted. The authors suggest that more evaluative work is required to ensure the validity of the measurement properties of the tools utilized to measure depression symptom severity in adolescents with depression. This work should include engagement of youth and caregivers in evaluation of the content validity (eg, the relevance, comprehensibility, and comprehensiveness) of these PROMs., Diversity and Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Based on ecosystem theory and genetic and environmental research paradigms, the current research explored the influence mechanism of interpersonal relationship and OXTR gene rs1042778, rs2254298 and rs53576 polymorphisms on adolescent depression and NSSI., Method: The main study investigation explored the effect of the interaction between interpersonal relationship and OXTR gene on adolescent depression and Non-Suicidal Self-Injury (NSSI). Concurrently, a supplementary examination investigated oxytocin's physiological impact on the social-emotional behaviors of mice subjected to post-weaning social isolation., Results: OXTR gene rs2254298 and rs53576 moderated the influence of interpersonal relationship on adolescent depression, and rs2254298 also moderated the influence of interpersonal relationship on adolescent NSSI. PWSI reduced the mice's emotional social ability and affected the expression and transcription of OXT and OXTR mRNA, which could be reversed after an appropriate dose of oxytocin treatment., Conclusion: Interaction between interpersonal relationship and the OXTR gene affects adolescent depression and NSSI. The OXTR gene heterozygous genotype individuals were more sensitive to environmental stimuli, supporting the differential susceptibility model., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Antidepressants are the main drugs used to treat depression, but they have not been shown to be effective in the treatment of child and adolescent depression. However, many adolescent depression treatment guidelines still recommend the use of antidepressants, especially specific serotonin re-uptake inhibitors. Previous studies have suggested that antidepressants have little therapeutic effect but many side effects, such as switching to mania, suicide, and non-suicidal self injury (NSSI), in the treatment of child and adolescent depression. In the process of developing guidelines, drug recommendations should not only focus on improving symptoms, but they should also consider potential side effects. This review discusses the serious side effects of antidepressants, including switching to mania, suicide, and NSSI., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Although many studies have examined the relationship between suicidal ideation and psychosocial factors in adolescents, there are differences between the results., Methods: Adopting the ecological model of health behavior as a theoretical framework, this study assessed individual, interpersonal and organizational factors associated with the prevalence of suicidal ideation and preventive behaviors in 305 Chinese adolescents hospitalized with depression. Clinical and demographic data were collected by a self-administered questionnaire. The Hamilton Depression Scale (HAMD) and suicidal ideation were assessed by interview., Results: The prevalence of suicidal ideation among the sample was 75.7% (231/305). Logistic regression showed that the increase of suicide ideation was associated with woman (OR = 2.237, 95%CI = 1.074-4.659), degree of depression(moderate depression: OR = 10.198, 95%CI = 3.819-27.237; major depression: OR = 21.677, 95%CI = 7.006-67.076), and high emotion-oriented coping(OR = 1.985, 95%CI = 0.977-4.034). However, high psychological resilience had lower rates of suicidal ideation (OR = 0.384, 95%CI = 0.158-0.933)., Conclusion: These findings highlight the need to pay sufficient attention to individuals with these risk factors for suicidal ideation in clinical work and to prevent suicidal behaviors by increasing health promotion behaviors., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Adolescent depression is a health issue influenced by various factors, with the impact of environmental factors, particularly air pollution, being insufficiently understood. This study investigates the relationship between particulate matter (PM2.5) and adolescent mental health., Methods: A survey of middle school students in two rural counties of Hubei Province-Tongcheng and Lichuan-was conducted using multi-stage probability sampling. Data on demographics, mental health, and social conditions were collected via self-administered questionnaires. PM2.5 exposure levels were obtained from the NASA Giovanni database using a two-step machine learning model. Depression levels were measured with the PHQ-9 scale. Generalized linear regression and structural equation modeling were used to analyze the relationship between PM2.5 and depression., Results: The study included 2780 valid responses (mean age 13.49 years, 52.73% male). The findings indicated a correlation between PM2.5 exposure, left-behind children status, and negative coping strategies with higher PHQ-9 scores. Each unit increase in PM2.5 was associated with a 1.004 increase in the PHQ-9 score (P < 0.01). Left-behind children had scores 1.023 times higher than their peers (P = 0.039), while positive coping correlated with lower scores (RR = 0.855, P < 0.001). The influence of PM2.5 on depression was fully indirect, mediated by personal traits and family/community environments (β = -0.003, P = 0.855)., Limitations: The cross-sectional design limits causal inferences, and self-reporting may introduce bias. The focus on middle schoolers from two counties may limit broader applicability., Conclusions: This research underscores the complex factors contributing to adolescent depression, with individual characteristics playing a crucial role. The impact of air pollution on depression is mediated by personal traits and the community environment., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lu Ma reports administrative support was provided by Education Bureau of Tongcheng County, Hubei Province. Ma Lu reports administrative support was provided by Education Bureau of Lichuan City, Hubei Province. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Adolescence is a critical period marked by significant psychological changes. This study explores how self-efficacy and parental parenting styles may influence the risk of severe depression among teens. The hypothesis is that higher self-efficacy and authoritative parenting patterns will be negatively correlated with severe depression in adolescents., Aim: To investigate the correlation between self-efficacy, parenting patterns and major depression in adolescents, and to provide guidance for mental intervention., Methods: Using a cross-sectional survey design, the data were collected through a questionnaire survey. Patients with major depression and healthy adolescents in the hospital control group were selected as the study objects. The General Self-Efficacy Scale, the Parenting Style Evaluation Scale, and the Beck Depression Inventory were used as research instruments. Data input and statistical analysis were performed, including descriptive statistics, correlation analysis, through SPSS software., Results: The study found that depressed patients had significantly lower self-efficacy than healthy controls, and parenting style was significantly associated with depressive symptoms in terms of emotional warmth and understanding, punishment severity, and denial. Specifically, parental emotional warmth and understanding were significantly negatively associated with depressive symptoms, while parental punishment severity and denial were significantly positively associated with depressive symptoms. Self-efficacy showed a significant negative correlation with depressive symptoms, indicating that higher self-efficacy had lower depressive symptoms., Conclusion: Adolescent major depressive disorder patient was significantly associated with their parenting style and self-efficacy. Higher self-efficacy is associated with decreased depressive symptoms, so improving adolescent self-efficacy and improving parenting style are important., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To investigate the effects of depression on non-suicidal self-injury (NSSI) and related psychological conditions in adolescents with unipolar disorder (UD) and bipolar disorder (BD), and to provide a basis for accurate prevention and intervention of NSSI behaviors in adolescents., Methods: This cross-sectional study collected data from adolescents aged 12-18 years with depressive episodes who exhibited NSSI behaviors and attended the psychiatric outpatient clinic of Huangshi City Psychiatric Specialized Hospital from 2018 to 2023. Depressive episodes were clinically diagnosed by two psychiatrists according to the ICD-10., Results: In terms of NSSI behavioral patterns and severity, adolescents with UD displayed more frequent behaviour of intentionally burning themselves with cigarettes and had more instances of self-inflicted suicidal thoughts that were not carried out compared to those with BD, and the differences between the two groups were statistically significant (P < 0.05). For psychological status, Nurses' Global Assessment of Suicide Risk (NGASR) scores were significantly higher in adolescents with BD than in those with UD (P < 0.05). There was a significant negative correlation between anxiety scores and the frequency of NSSI in adolescents with BD (P < 0.05); that is, the more anxious the adolescents with BD, the lower the frequency of NSSI. The NGASR scores of adolescents with UD and BD were significantly and positively correlated with the frequency of NSSI occurrences (P < 0.05); higher NGASR scores of adolescents with UD and BD corresponded with higher frequencies of NSSI., Conclusion: The differences in NSSI behaviors between adolescents with UD and those with BD were statistically significant in terms of self-injury method and severity. Adolescents with UD experienced more severe consequences related to NSSI behaviors. Regarding psychological conditions, adolescents with BD are at a higher risk of suicide. An inverse relationship was observed between anxiety severity and the frequency of NSSI in adolescents with BD; severe anxiety was associated with lower NSSI frequency. Additionally, higher suicide risk was associated with a higher frequency of NSSI in adolescent patients with either UD or BD. Therefore, different prevention and intervention measures are needed to address NSSI behaviors in adolescents with UD and BD., Competing Interests: Declarations. Ethics approval and consent to participate: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. This study was approved by the Ethics Committee of Huangshi Psychiatric Hospital (Grant No.: HSMHC20231201). Informed consent was obtained from all participants in this study. For minors, we have obtained informed consent from their guardians. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The psychosocial factors play an important role in the development of depression in adolescents. we used metabolomics techniques to explore the links among childhood trauma, rumination, resilience, and adolescent depression., Methods: We selected 57 adolescent depression patients and 53 healthy adolescents. The Childhood Trauma Questionnaire (CTQ), Hamilton Depression Scale (HAMD), Resilience Scale (CD-RISC), and Redundant Thinking Response Scale (RRS) were employed for the purpose of psychological assessment. The patients were regrouped according to their scores using the 27% high-low grouping method. Blood specimens were collected from all adolescents and metabolic data were obtained using LC-MS., Results: We found no statistically significant difference between the groups in terms of age, gender, and body mass index (BMI). HAMD, CTQ, and RRS scores were significantly higher in the adolescent depression group (MDD) than in the adolescent healthy control group (HC), and CD-RISP scores were significantly lower than in the HC group (P < 0.001). There were significant differences between the low childhood trauma group (LCT) and high childhood trauma group (HCT), the low rumination group (LRR) and high rumination group (HRR), and the low resilience group (LPR) and high resilience group (HPR) (P < 0.001). RRS, CTQ and HAMD scores were positively correlated, RRS and CTQ scores were positively correlated, CD-RIS was negatively correlated with HAMD, RRS and CTQ scores (P < 0.01). More importantly, we found that DHEAS and LPA (22:6) were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood trauma groups. N-Acetyl-L-aspartic acid and DHEAS were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood rumination groups. Pseudouridine and LPA(22:6) were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood resilience groups., Conclusion: Psychological factors (childhood trauma, rumination, resilience) are biologically linked to the development of depression in adolescents. The impact of rumination on adolescent depression may be associated with DHEA. The impact of childhood trauma and resilience on adolescent depression may be associated with LPA (22:6)., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all participants for this study. In the case of participants under the age of 16, informed consent was obtained from both the participants themselves and their legal guardians. The study was reviewed and approved by the Medical Ethics Committee of The Affiliated Hospital of Guizhou Medical University and was in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: We aim to use large language models (LLMs) to detect mentions of nuanced psychotherapeutic outcomes and impacts than previously considered in transcripts of interviews with adolescent depression. Our clinical authors previously created a novel coding framework containing fine-grained therapy outcomes beyond the binary classification (eg, depression vs control) based on qualitative analysis embedded within a clinical study of depression. Moreover, we seek to demonstrate that embeddings from LLMs are informative enough to accurately label these experiences., Materials and Methods: Data were drawn from interviews, where text segments were annotated with different outcome labels. Five different open-source LLMs were evaluated to classify outcomes from the coding framework. Classification experiments were carried out in the original interview transcripts. Furthermore, we repeated those experiments for versions of the data produced by breaking those segments into conversation turns, or keeping non-interviewer utterances (monologues)., Results: We used classification models to predict 31 outcomes and 8 derived labels, for 3 different text segmentations. Area under the ROC curve scores ranged between 0.6 and 0.9 for the original segmentation and 0.7 and 1.0 for the monologues and turns., Discussion: LLM-based classification models could identify outcomes important to adolescents, such as friendships or academic and vocational functioning, in text transcripts of patient interviews. By using clinical data, we also aim to better generalize to clinical settings compared to studies based on public social media data., Conclusion: Our results demonstrate that fine-grained therapy outcome coding in psychotherapeutic text is feasible, and can be used to support the quantification of important outcomes for downstream uses., (Published by Oxford University Press on behalf of the American Medical Informatics Association 2024.)

Background: Abnormal cognitive response to pain is consistently associated with deleterious outcomes among adolescents with depression. Highly relevant to both pain and cognition, dorsolateral prefrontal cortex (DLPFC) is important to understanding pain cognition. Our study aimed to characterize the circuit of DLPFC and the efficacy of transcranial magnetic stimulation (TMS) over DLPFC on pain cognition in adolescents with depression., Methods: Using neuroimaging data, we first compared functional connectivity (FC) of DLPFC between 60 adolescents with depression and 65 controls. The patients were then divided into add-on TMS group (N = 30) and Sertraline group (N = 30). Clinical outcome was determined using Pain Vigilance and Awareness Questionnaire (PVAQ) and Pain Catastrophizing Scale (PCS). Finally, we conducted regression analysis to assess the effect that FC of DLPFC contributes to in predicting clinical outcome., Results: FC analysis showed that compared to controls, patients displayed hyperconnection of left DLPFC - left triangular part of inferior frontal gyrus (IFG), which was significantly correlated with higher PCS total-, magnification- and helplessness-scores. Patients also showed hyperconnection of right DLPFC - right supramarginal gyrus (SMG), which was correlated with lower PCS total- and rumination- scores. After intervention, the add-on TMS group displayed significantly decreased score on PVAQ, PCS total and rumination. FC of left DLPFC - bilateral triangular part of IFG, - right SMG, as well as right DLPFC - left putamen, could predict the improvement of pain vigilance and magnification., Conclusion: Our results point to a key role of DLPFC acting as a connection linking cognitive control and pain processing in adolescents with depression., Trial Registration: The study is registered in https://www.chictr.org.cn/ with a registration number ChiCTR2000039503 (date: 10.30.2020)., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the First Hospital of Shanxi Medical University with the approval number K062. All participants and their guardians provided written informed consent. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Cases of depression among adolescents are gradually increasing. The study of the physiological basis of cognitive function from a biochemical perspective has therefore been garnering increasing attention. Depression has been hypothesized to be associated with the brain biochemical metabolism of the anterior cingulate gyrus, frontal lobe white matter, and the thalamus., Aim: To explore the application of proton magnetic resonance spectroscopy ( 1 H-MRS) in the metabolic alterations in the prefrontal white matter (PWM) and gray matter (GM) in adolescents with depression., Methods: 1 H-MRS was performed for semi-quantitative analysis of the biochemical metabolites N-acetylaspartate (NAA), choline (Cho) complexes, creatine (Cr), and myo-inositol (mI) in bilateral PWM, anterior cingulate GM, and thalami of 31 adolescent patients with depression (research group) and 35 healthy adolescents (control group), and the NAA/Cr, Cho/Cr, and mI/Cr ratios were calculated. Meanwhile, Hamilton Depression Scale (HAMD) and Wechsler Memory Scale were used to assess the degree of depression and memory function in all adolescents. The correlation of brain metabolite levels with scale scores was also analyzed., Results: The research group had markedly higher HAMD-24 scores and lower memory quotient (MQ) compared with the control group ( P < 0.05). Adolescents with depression were found to have lower bilateral PWM NAA/Cr and Cho/Cr ratios compared with healthy adolescents ( P < 0.05). The mI/Cr ratios were found to be similar in both groups ( P > 0.05). The bilateral anterior cingulate GM NAA/Cr, Cho/Cr, and mI/Cr also did not demonstrate marked differences ( P > 0.05). No statistical inter-group difference was determined in NAA/Cr of the bilateral thalami ( P > 0.05), while bilateral thalamic Cho/Cr and mI/Cr were reduced in teenagers with depression compared with healthy adolescents ( P < 0.05). A significant negative correlation was observed between the HAMD-24 scores in adolescents with depression with bilateral PWM NAA/Cr and Cho/Cr and were inversely linked to bilateral thalamic Cho/Cr and mI/Cr ( P < 0.05). In adolescents with depressions, MQ positively correlated with right PWH NAA/Cr, left PWH Cho/Cr, and bilateral thalamic Cho/Cr and mI/Cr., Conclusion: PWM and thalamic metabolic abnormalities might influence teen depression, and the reduction in bilateral PWM NAA/Cr and Cho/Cr could be related to the neuropathology of adolescents with depression suffering from memory impairment. There exists a possibility of dysfunction of nerve cell membrane phospholipids in the thalami of adolescent patients with depression., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Adolescent depression is a growing global health concern, affecting 14% of adolescents and leading to severe consequences such as academic failure, substance abuse, and suicidal ideation. The study by Yu et al , investigates the cognitive and social factors influencing depression in 795 Chinese adolescents. Findings reveal that negative life events (NLEs) and dysfunctional attitudes are strongly associated with depressive symptoms, while social support moderates the impact of NLEs but not dysfunctional attitudes. The study highlights the need for cognitive-behavioural interventions targeting perfectionism and autonomy, and the importance of strengthening social support systems in schools and communities. Culturally sensitive, holistic approaches to adolescent mental health are crucial for addressing both the internal vulnerabilities and external pressures contributing to depression. Further research is needed to explore the roles of peer and parental support and the long-term effects of these factors across diverse cultural contexts., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Given worsening youth mental health over the past years, mobile medical units are a potential avenue to increase access to mental healthcare services. Methods: This 1-year retrospective study examined a self-administered psychosocial assessment, and referrals made to mental health services for adolescent patients served by a mobile medical unit. We extracted psychosocial assessment responses, Patient Health Questionnaire (PHQ-9) scores, and mental health referral information for patients seen by the mobile medical unit in 2022 and examined rates and predictors of depression and referral to mental health services. Results: Of the 326 patients who completed the psychosocial assessment, one in five had moderate to severe depression symptoms based on PHQ-9 scores. Factors associated with referral to mental healthcare included female gender identity, LGBTQ+ identity, and several factors from the psychosocial assessment. Additionally, 13.8% wanted a mental health referral, and 16.6% were referred to mental healthcare. Patients who desired to see a mental health provider had higher odds of being referred ( p < 0.0001). All patients with moderate to severe depression who were not already connected to mental healthcare and wanted a referral were referred. Conclusion: This study documents the impact of a mobile medical unit programme in identifying adolescent patients with mental health needs and referring them to mental healthcare.

Background: The school climate concept has been promising, but has long-standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations., Contributions to Theory: The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co-promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well-established, high-impact constructs. CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The School as a Protective Factor approach presents a simple, easy-to-use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools., (© 2024 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Purpose: Delaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups of adolescents., Methods: We examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy., Results: Over 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies., Conclusion: High school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: The conceptual framework for School as a Protective Factor approach was presented in a companion article in this issue of the journal. The current article describes the validation of the School as a Protective Factor-Brief (SPF-Brief), a 13-item survey measuring the 3 core constructs and 13 defining characteristics of this framework., Methods: The SPF-Brief was validated through 2 studies. The developmental study used a longitudinal design including 1349 participants who completed surveys over 5 semesters, while the validation study used a cross-sectional design with 2775 participants. Both studies included middle and high school students. Factor analysis, growth model analysis, criterion-related validation, and outcome analysis were employed., Results: Analyses provided strong evidence supporting the reliability and validity of the instrument and conceptual framework. Higher SPF-Brief scores were associated with higher math grades, English grades, and quality of life, as well as lower rates of anxiety, depression, conduct disorder, alcohol, e-cigarette, tobacco, and cannabis use. Effect size estimates ranged from moderate to strong., Conclusions: These findings suggest the utility of the SPF-Brief instrument and the School as a Protective Factor framework. Together, they may offer advantages to the traditional school climate approach., (© 2024 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Depression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22-12.83), anxiety disorders (4.05; 1.77-9.27), suicidality (5.37; 2.28-12.66), and AUD (7.68; 2.59-22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21-0.95) and AUD in adulthood (0.18; 0.07-0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course., (© 2024. The Author(s).)

Background: Previous research has indicated that personality traits, loneliness, and problematic internet use (PIU) significantly contribute to the prevalence of adolescent depression. However, the specific interrelationships among these variables in explaining the occurrence of depression remain unclear. Drawing upon susceptibility theory and cognitive-behavioral theory, this study explored whether personality traits influences adolescent depression through loneliness and PIU., Methods: A total of 2476 adolescents (aged 12-18) from all over the country completed a psycho-social test, including the 10-Item Big Five Personality Inventory (BFI-10), three-Item Loneliness Scale (T-ILS), Problematic Internet Use Questionnaire-Short Form (PIUQ-SF-6) and the Patient Health Questionnaire-9 (PHQ-9). The mediation model was built and bootstrap method was used to test the mediating effect., Results: Results showed that neuroticism, conscientiousness, openness, and agreeableness have a direct role on depression. Loneliness and PIU partially mediated the relationship between neuroticism, conscientiousness, agreeableness and depression, and completely mediated the relationship between extroversion and depression., Conclusions: The results suggest that loneliness and PIU play important mediating roles in the relationship between personality traits and depression. This remind us that alleviating sense of loneliness and reducing overuse of the internet are a strategy for improve depression among adolescents., (© 2024. The Author(s).)

We examined the association between parental problematic internet use (PIU) and adolescent depression and whether this association varied based on internet-related rules. We recruited adolescents ages 13-18 and their parent using national Qualtrics panels (N = 4592 dyads). Measures included the Problematic and Risky Internet Use Screening Scale (PRIUSS-3), the Patient Health Questionnaire (PHQ-9), and the internet specific parenting practice scale (ISPPS). Parental PIU was associated with symptoms of adolescent depression, including suicidal ideation, even when controlling for adolescent PIU (β = 0.35, 95% CI [0.32, 0.38]). Time-related rules moderated this association in a non-linear way where the association was strongest when time-related rules were unclear / mid-range. The moderation effect was linear for content-related rules, where stricter rules were associated with a weaker association between parent PIU and adolescent depression. Results support clinicians assessing parent PIU when treating depressed adolescents and engaging parents in monitoring their adolescents' internet use content., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems., (© 2024. The Author(s).)

Objective: To investigate the association between single nucleotide polymorphisms (SNPs) of tryptophan hydroxylase 2 (TPH2) (rs11178997, rs11178998, and rs120074175) and negative life events in adolescent depression with Non-suicidal self-injury (NSSI)., Methods: Genomic DNA was extracted from 197 adolescents with depression (participants group, including NSSI group and non-NSSI group), as well as from 100 healthy controls (control group), in northern China. PCR technology was utilized to amplify DNA fragments and detect genotypes in both groups. The Adolescent Life Event Scale (ASLEC) was employed to conduct a questionnaire survey among the participants and control groups. Differences in allele and genotype frequency distribution between the two groups were analyzed using the X^2 test, while generalized multifactor dimensionality reduction (GMDR) was used to analyze gene-environment interactions., Results: Significant differences were observed in ASLEC scores between the control group and both the NSSI group and non-NSSI group (P<0.05). Additionally, significant differences were found in the interpersonal relationship factor and punishment factor between the NSSI group and non-NSSI group (P < 0.05). Moreover, a significant difference was identified in SNP genotype of rs11178997 between the depression group (NSSI group + non-NSSI group) and control group (P<0.05). GMDR analysis revealed an interaction among rs11178997, rs11178998, and ASLEC., Conclusion: Adolescents with depression, particularly females, may exhibit a tendency to employ NSSI as an emotional coping mechanism when confronted with greater family and interpersonal challenges. The AT genotype of TPH2 gene locus rs11178997 is more prevalent among adolescents with depression. Furthermore, the occurrence of NSSI may be associated with an interaction involving polymorphic sites rs11178997 and rs11178998 along with life events., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Liu et al.)

The onset of depression commonly occurs in adolescence; therefore, depressive prevention and intervention are pivotal during this period. It is becoming evident that neurotransmitter imbalance and gut microbiota dysbiosis are prominent causes of depression. However, the underlying links and mechanisms remain poorly understood. In this study, with 16S ribosomal RNA gene sequencing, genus Coprococcus markedly differentiated between the healthy and unmedicated depressive adolescents. Based on this, transplantation of Coprococcus eutactus (C.e.) was found to dramatically ameliorate the chronic restraint stress (CRS) induced depression-like changes and prevent synaptic loss and glial-stimulated neuroinflammation in mice. The Ultra-high performance liquid chromatography tandem mass spectrometry analysis (UHPLC-MS/MS) further showed that neurotoxic neurotransmitters in kynurenine pathway (KP) such as 3-hydroxykynurenine (3-HK) and 3-hydroxyanthranilic acid (3-HAA) decreased in mouse brains, mechanistically deciphering the transfer of the tryptophan metabolic pathway to serotonin metabolic signaling in the brain after C.e. treatment, which was also verified in the colon. Molecularly, blockage of KP activities mediated by C.e. was ascribed to the restraint of the limit-step enzymes responsible for kynurenine, 3-HK, and quinolinic acid generation. In the colon, C.e. treatment significantly recovered goblet cells and mucus secretion in CRS mice which may ascribe to the rebalance of the disordered gut microbiota, especially Akkermansia, Roseburia, Rikenella, Blautia, and Alloprevotella. Taken together, the current study reveals for the first time the beneficial effects and potential mechanisms of C.e. in ameliorating CRS-induced depression, unraveling the direct links between C.e. treatment and neurotransmitter rebalance, which may provide efficacious therapeutic avenues for adolescent depressive intervention., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Treating depression in adolescents is a significant challenge, and major depressive disorder (MDD) with suicidal ideation and treatment-resistant depression (TRD) are common and potentially devastating to optimal psychological and physical development in this age group. Suicide is among the leading causes of youth mortality, and TRD occurs in up to 40% of adolescents with MDD. TRD involves severe, persistent symptoms that are hard to treat, significantly reducing functioning and quality of life. We conducted a literature search focusing on key terms related to ketamine and esketamine for MDD with suicidal ideation and TRD in adolescents, aiming to review the potential utility of these molecules in adolescents for these conditions. Ketamine has shown efficacy in reducing depressive symptoms in adolescents with TRD. Esketamine has shown efficacy in reducing depressive symptoms and treating suicidal ideation in adolescents. Both ketamine and esketamine have demonstrated favorable safety and tolerability profiles. Using these drugs for serious conditions like adolescent MDD with suicidal thoughts and TRD can effectively treat symptoms, reduce self-harm and suicide risks, and provide a window for longer-term therapeutic interventions. The prompt and effective treatment of TRD could improve adolescents' quality of life. However, more research is needed to optimize treatment protocols and evaluate long-term effects.

Objective: To investigate parental knowledge, attitudes, and practices (KAP) toward adolescent depression., Methods: A cross-sectional survey was conducted between October 2022 and October 2023 at The First Affiliated Hospital of Ningbo University among parents of adolescents diagnosed with depression. A self-administered questionnaire was used to collect the parents' demographic characteristics and KAP toward adolescent depression., Results: A total of 522 questionnaires were collected from parents of depressed adolescents. Among the participants, 383 (73.37%) were female. In addition, 426 participants (81.61%) had children aged 14-18. The mean knowledge, attitude, and practice scores were 9.09 ± 2.37 (possible range: 0-12), 37.04 ± 4.11 (possible range: 11-55), and 31.53 ± 3.84 (possible range: 8-40), respectively. There were significant positive correlations between knowledge and attitude ( r  = 0.225, p  < 0.001), knowledge and practice ( r  = 0.240, p  < 0.001), and attitude and practice ( r  = 0.381, p  < 0.001). The path analysis showed significant direct effects of knowledge on attitude (β = 0.422, p  < 0.001) and practice (β = 0.283, p  < 0.001). There was an indirect effect of knowledge on practice through attitude (β = 0.131, p  = 0.004). Attitude directly impacted practice (β = 0.311, p  < 0.001)., Conclusion: Parents of adolescents diagnosed with depression exhibited moderate KAP regarding adolescent depression. The study underscored the importance of targeted interventions to improve parental KAP in supporting adolescents with depression. Moreover, future research should explore additional factors influencing parental attitudes and behaviors toward adolescent depression to develop more effective interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gao, Dai, Lin, Ye, Yang, Zhang, Mao, Lou, Ji, Ruan and Hou.)

Objective: This study aims to explore the relationship between sleep patterns and depressive symptoms among adolescents, examining variations in depressive symptoms across different sleep qualities, durations, and habits., Method: A cross-sectional survey was conducted, gathering data from 8,775 Chinese adolescents on their demographics, lifestyle habits, sleep quality and duration, and depressive symptoms. The association between sleep parameters and depressive symptoms was analyzed using multivariate logistic regression., Findings: The findings reveal a significant correlation between sleep quality/duration and depressive symptoms. Specifically, adolescents with poor sleep quality had higher depressive scores (mean score = 14.62, standard deviation = 5.71), significantly exceeding those with better sleep quality (mean score = 11.54, standard deviation = 4.69). Adolescents with shorter sleep duration also showed significantly higher depressive scores than those with moderate sleep duration. Importantly, adolescents experiencing both poor sleep quality and shorter sleep duration were at a significantly increased risk of depressive symptoms (OR = 4.04, 95% CI: 3.53-4.62, P < 0.001). Further analysis indicated that older age and lower family economic status were independent predictors of a higher risk of adolescent depression (OR = 1.22, 95% CI: 1.08-1.38, P = 0.001), whereas factors such as gender, ethnicity, residence, being an only child, and parental education levels were not statistically significant., Conclusion: Among Chinese adolescents, poor sleep quality and shorter sleep duration are independent predictors of higher depressive symptom scores. Adolescents experiencing both of these conditions simultaneously have a significantly increased risk of depressive symptoms. Furthermore, older age and lower family economic status are also significantly related to an increased risk of depression in adolescents. These findings emphasize the importance of improving sleep quality and optimizing sleep duration for the prevention of adolescent depression. They also suggest the need for a comprehensive approach that addresses the multifaceted factors influencing adolescent mental health, including sleep patterns and socioeconomic disparities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Dou, Yang, Luo and Yang.)

Purpose: The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022., Methods: We conducted an integrative systematic literature review. Three reviewers participated at different stages of article review. Of the 2234 articles identified in three databases (Pubmed, ProQuest Central, Ebscohost), 10 met inclusion criteria (i.e., adolescent aged United States populations, included information about birth cohort and survey year, focused on depressive symptoms/disorders)., Results: All 10 articles observed increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, declining mental health stigma, increased treatment, and, in more recent years, the COVID-19 pandemic., Conclusions: Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991 to 2020. Mechanisms driving this increase are still unknown. Research to identify these mechanisms is needed to inform depression screening and intervention efforts for adolescents., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: The incidence of adolescent depression has markedly risen in recent years, with a high recurrence rate into adulthood. Diagnosis in adolescents is challenging due to subjective factors, highlighting the crucial need for objective diagnostic markers., Methods: Our study enrolled 204 participants, including healthy controls (n = 88) and first-episode adolescent depression patients (n = 116). Serum samples underwent gas chromatography-mass spectrometry (GC-MS) analysis to assess non-esterified fatty acids (NEFA) expression. Machine learning and ROC analysis were employed to identify potential biomarkers, followed by bioinformatics analysis to explore underlying mechanisms., Results: Nearly all differentially expressed NEFA exhibited significant downregulation. Notably, nonanoic acid, cis-10-pentadecenoic acid, cis-10-carboenoic acid, and cis-11-eicosenoic acid demonstrated excellent performance in distinguishing adolescent depression patients. Metabolite-gene interaction analysis revealed these NEFAs interacted with multiple genes. KEGG pathway analysis on these genes suggested that differentially expressed NEFA may impact PPAR and cAMP signaling pathways., Limitations: Inclusion of diverse populations for evaluation is warranted. Biomarkers identified in this study require samples that are more in line with the experimental design for external validation, and further basic research is necessary to validate the potential depressive mechanisms of NEFA., Conclusions: The overall reduction in NEFA expression in first-episode adolescent depression patients suggests a potential mediation of depression symptoms through cAMP and PPAR signaling pathways. NEFA levels show promise as a diagnostic tool for identifying first-episode adolescent depression patients., Competing Interests: Declaration of competing interest There is none conflict of interest on this research., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Among adolescents with depression, the occurrence of non-suicidal self-injury (NSSI) behavior is prevalent, constituting a high-risk factor for suicide. However, there has been limited research on the neuroimaging mechanisms underlying adolescent depression and NSSI behavior, and the potential association between the two remains unclear. Therefore, this study aims to investigate the alterations in functional connectivity (FC) of the regions in the prefrontal cortex with the whole brain, and elucidates the relationship between these alterations and NSSI behavior in adolescents with depression., Methods: A total of 68 participants were included in this study, including 35 adolescents with depression and 33 healthy controls. All participants underwent assessments using the 17-item Hamilton Depression Rating Scale (17-HAMD) and the Ottawa Self-Harm Inventory. In addition, functional magnetic resonance imaging (fMRI) data of the participants' brains were collected. Subsequently, the FCs of the regions in the prefrontal cortex with the whole brain was calculated. The FCs showing significant differences were then subjected to correlation analyses with 17-HAMD scores and NSSI behavior scores., Result: Compared to the healthy control group, the adolescent depression group exhibited decreased FCs in several regions, including the right frontal eye field, left dorsolateral prefrontal cortex, right orbitofrontal cortex, left insula and right anterior cingulate coetex. The 17-HAMD score was positively correlated with the frequency of NSSI behavior within 1 year (r s = 0.461, p = 0.005). The FC between the right anterior cingulate cortex and the right precuneus showed a negative correlation with the 17-HAMD scores (r s = -0.401, p = 0.023). Additionally, the FC between the right orbitofrontal cortex and the right insula, demonstrated a negative correlation with the frequency of NSSI behavior within 1 year (r s = -0.438, p = 0.012, respectively)., Conclusion: Adolescents with depression showed decreased FCs of the prefrontal cortex with multiple brain regions, and some of these FCs were associated with the NSSI frequency within 1 year. This study provided neuroimaging evidence for the neurophysiological mechanisms underlying adolescent depression and its comorbidity with NSSI behavior., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Guo, Lu, Ou, Huang, Li, Cui, Li, Zheng, Liang, Qiu and Liu.)

Background: Depressive episodes in adolescents are often accompanied by various physical symptoms, but few studies have explored the association between depression and fever, This case study is the first to report the relationship between unexplained recurrent high fever and depression., Case Presentation: H is a 15 year old adolescent female currently in junior year. 2 + months ago, H gradually felt depressed after a class change. Around the time, the patient suddenly developed chills with no obvious trigger and fever. H was treated with anti-infective and anti-viral treatments all of which did not show significant improvement. No significant abnormality was seen in any of the related examinations. Considering that the patient's anxiety, depression and somatic symptoms were obvious during the course of the disease, she was given venlafaxine hydrochloride extended-release capsule 75 mg/d; tandospirone citrate capsule 10 mg Bid; alprazolam tablets 0.4 mg qn to improve mood and sleep; supplemented with transcranial repetitive magnetic stimulation therapy 2 times/d; visible light therapy 1 time/d and psychological counseling once. Over the 6 days of treatment, the patient's body temperature gradually returned to the normal range and her mood improved significantly., Conclusion: Depression should be considered a potential cause of unexplained recurrent fevers in adolescents, even when the temperature is significantly outside the normal range., (© 2024. The Author(s).)

Background: Antidepressant response in adults with major depressive disorder (MDD) is probably influenced by personality dimensions. However, personality dimensions in depression and their association with antidepressant treatment in adolescents are relatively unknown. We sought to investigate whether personality traits (PTs) can influence antidepressant treatment response in adolescents with depression., Methods: Eighty-two adolescents with MDD who had completed the 8 weeks of treatment with selective serotonin reuptake inhibitors (SSRI) were enrolled. The Revised NEO Five-Factor Inventory (NEO-FFI-R) was used to measure their personality at baseline, and the 17-item Hamilton Depression Rating Scale (HAMD-17) and Children's Depression Rating Scale-Revised (CDRS-R) were used to evaluate depressive symptoms at baseline and 8 weeks. Moreover, logistic regression was performed to investigate the relationship between personality dimensions and antidepressant response. Receiver operating characteristic analyses were employed to determine the accuracy of a PT-based model in predicting the antidepressant response rate., Results: Adolescents with MDD had significantly different PTs at baseline. Multivariable logistic regression analysis showed that extroversion scores were associated with response to antidepressant treatment, the lower the extroversion score, the better the response to antidepressant treatment, after correcting for variables with significant differences and trends or all potential confounding variables. It was also found that the combination of disease duration, extraversion-gregariousness, and agreeableness-trust effectively predicted antidepressant response in adolescents with MDD, with a sensitivity of 79.4 % and specificity of 68.7 %., Conclusion: Personality dysfunction in adolescents is associated with MDD. The antidepressant treatment response is influenced by the degree of extroversion in adolescents with MDD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: We evaluated the presence and impact of unblinding during the influential Treatment for Adolescents with Depression Study (ClinicalTrials.gov Identifier: NCT00006286)., Method: Our analysis was part of a Restoring Invisible and Abandoned Trials reanalysis. Treatment for Adolescents with Depression Study trialled fluoxetine, placebo, cognitive behaviour therapy or their combination, in treating adolescents with major depressive disorder. We analysed the accuracy of guesses of fluoxetine or placebo allocation, and their effects on change in Children's Depression Rating Scale-Revised at 12 weeks., Results: Of 221 participants allocated to fluoxetine or placebo, 151 adolescents (68%) had their guess about pill-treatment-arm allocation recorded at week 6, and guesses were recorded for 154 independent evaluators, 159 parents and 164 pharmacotherapists. All of these groups guessed treatment allocation more accurately than would be expected by chance (60-66% accuracy; all p -values ⩽ 0.004). Guesses did not become more accurate between 6 and 12 weeks and were not predicted by adverse events, though event documentation was poor. Treatment guess had a substantial and statistically significant effect on outcome (Children's Depression Rating Scale-Revised change mean difference 9.12 [4.69; 13.55], β = 0.334, p < 0.001), but actual treatment arm did not (1.53 [-2.83; 5.89], β = 0.056, p = 0.489). Removing guess from the analysis increased the apparent effect of treatment arm, making it almost statistically significant at the conventional alpha-level of 0.05 ( p = 0.06)., Conclusions: For Treatment for Adolescents with Depression Study, treatment guesses strongly predicted outcomes and may have led to the exaggeration of drug effectiveness in the absence of actual effects. The integrity of double-blinding in trials should be routinely assessed and reported., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: J.J. affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. J.M. is involved in grant-funded research on methods to reduce antidepressants, receives royalties from books on psychiatric drugs and is co-chair person of the unfunded Critical Psychiatry Network.

Background: Childhood trauma is a pivotal risk factor for adolescent depression. While the association between childhood trauma and depression is well-established, the mediating role of self-concept has not been acknowledged. Specifically, limited attention has been paid to how childhood maltreatment impacts adolescent depression through physical and social self-concept, both in clinical and community samples. This study aims to investigate how distinct and cumulative childhood trauma affects adolescent depression, as well as the potential mediating role of self-concept in their relationships., Methods: We recruited 227 depressed adolescents (dataset 1, 45 males, age = 15.34 ± 1.96) and 574 community adolescents (dataset 2, 107 males, age = 16.79 ± 0.65). Each participant was assessed on five subtypes of childhood trauma severity, cumulative trauma index, physical and social self-concept, and depression. Mediation models were tested separately in the clinical and community samples., Results: Clinically depressed adolescents experienced a higher level of trauma severity, a greater number of trauma subtypes, and had lower levels of physical and social self-concept compared to community adolescents. Analyses on childhood trauma severity and cumulative trauma index jointly indicated that physical and social self-concept played mediation roles in the relationships between childhood trauma experiences and depression. Moreover, the mediating effects of self-concept were stronger in depressed adolescents when compared to community samples., Conclusions: Our findings suggest that physical and social self-concept play mediating roles in the pathway linking childhood trauma and adolescent depression, particularly in clinically depressed individuals., (© 2024. The Author(s).)

Background: Current research has been focusing on non-suicidal self-injury (NSSI) behaviors among adolescents with depression. Although family intimacy and adaptability are considered protective factors for NSSI, evidence supporting this relationship is lacking., Objective: This study aims to examine the mechanisms operating in the relationship between family intimacy and adaptability and NSSI behaviors among adolescents., Methods: A self-administered general demographic information questionnaire, the Behavioral Functional Assessment Scale for Non-Suicidal Self-Injury, the Family Intimacy and Adaptability Scale, the Connor-Davidson Resilience Scale, and the Self-Assessment of Depression Scale were distributed among adolescents with depression in three tertiary hospitals in Jiangsu Province., Results: The relationship between family intimacy and adaptability and NSSI was assessed among 596 adolescents with depression. The results revealed the following: (1) Family intimacy and adaptability were negatively correlated with NSSI behavior. (2) Psychological resilience and depression levels acted as chain mediators in the relationship between family intimacy and adaptability and NSSI behavior., Conclusions: Enhancing psychological resilience, controlling depressive symptoms, and reducing depression severity among adolescents by improving their family intimacy and adaptability are conducive to preventing and mitigating their NSSI behaviors., (© 2024. The Author(s).)

Background: Early adversity is strongly linked to adolescent depression, but there is limited research on the impact of indirect exposure to adversity before birth and the distinct role of adversity before and after birth., Methods: A total of 1911 Chinese adolescents (48.8 % males; ages 11 to 19, Mean = 13.96) reported early adversities before and after birth, depression, negative self-cognition and perceived school climate. Structural equation model was used to test the association between early adversity before/after birth and adolescent depression, with negative self-cognition serving as a mediator and school climate as a moderator., Results: Adversity before birth was related to adolescent depression through the full mediating role of negative self-cognition. Furthermore, it was more associated with negative self-cognition in schools with a more favorable climate. Adversity after birth was related to adolescent depression through the partial mediating role of negative self-cognition, and school climate played a nonsignificant moderating role in the mediating path., Limitations: Early adversity was measured through adolescent reports, possibly generating recall bias. The cross-sectional design should be taken into consideration when drawing conclusions about causality., Conclusions: Adversities before and after birth are associated with adolescent depression in distinct ways. The more association between adversity before birth and negative self-cognition in a favorable school climate supports the "healthy context paradox." Interventions that target depression should focus on promoting a positive school climate and helping adolescents who have experienced early adversity bolster positive self-cognition., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: High dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement., Method: Data was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators., Results: The study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent's involvement and progress., Discussion: The research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cirasola, Szegedi, Fonagy and Midgley.)

Background: The prevalence of suicide is high among major depressive adolescents. Poor sleep quality has been documented as a significant risk factor for suicide, influencing perceived social support. Enhanced social support acts as a buffer against suicidal ideation and positively impacts resilience, reducing the prevalence of suicidal ideation. This reciprocal relationship between sleep quality, social support and resilience forms the basis for understanding the mechanisms contributing to suicidal ideation in major depressive adolescents., Methods: A total of 585 major depressive adolescents aged 11 to 24 years was conducted to explore these associations. Assessments included the Pittsburgh Sleep Quality Index, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale and Beck Scale for Suicide Ideation. Pearson correlation and Model 6 in the SPSS program were employed for chain mediating tests., Results: Better sleep quality positively predicted decreased suicide ideation (β = 0.207, p < 0.01) and predicted lower perceived social support (β = -0.226, p < 0.01) and resilience (β = -0.355, p < 0.01). Perceived social support positively predicted increased resilience (β = 0.422, p < 0.01) and negatively predicted suicide ideation (β = -0.288, p < 0.01). Resilience negatively predicted suicide ideation (β = -0.187, p < 0.01). Sleep quality indirectly predicted suicide ideation through perceived social support and resilience, with a mediation value of 0.0678 (95% CI [0.0359, 0.1060]), constituting 10.65% of the total effect., Conclusions: This study establishes that sleep quality indirectly predicts suicide ideation in major depressive adolescents, mediated independently by perceived social support and resilience., (© 2024 John Wiley & Sons Ltd.)

Background: Hippocampal disruptions represent potential neuropathological biomarkers in depressed adolescents with cognitive dysfunctions. Given heterogeneous outcomes of whole-hippocampus analyses, we investigated subregional abnormalities in depressed adolescents and their associations with symptom severity and cognitive dysfunctions., Methods: MethodsSeventy-nine first-episode depressive patients (ag = 15.54 ± 1.83) and 71 healthy controls (age = 16.18 ± 2.85) were included. All participants underwent T1 and T2 imaging, completed depressive severity assessments, and performed cognitive assessments on memory, emotional recognition, cognitive control, and attention. Freesurfer was used to segment each hippocampus into 12 subfields. Multivariable analyses of variance were performed to identify overall and disease severity-related abnormalities in patients. LASSO regression was also conducted to explore the associations between hippocampal subfields and patients' cognitive abilities., Results: Depressed adolescents showed decreases in dentate gyrus, CA1, CA2/3, CA4, fimbria, tail, and molecular layer. Analyses of overall symptom severity, duration, self-harm behavior, and suicidality suggested that severity-related decreases mainly manifested in CA regions and involved surrounding subfields with disease severity increases. LASSO regression indicated that hippocampal subfield abnormalities had the strongest associations with memory impairments, with CA regions and dentate gyrus showing the highest weights., Conclusions: Hippocampal abnormalities are widespread in depressed adolescents and such abnormalities may spread from CA regions to surrounding areas as the disease progresses. Abnormalities in CA regions and dentate gyrus among these subfields primarily link with memory impairments in patients. These results demonstrate that hippocampal subsections may serve as useful biomarkers of depression progression in adolescents, offering new directions for early clinical intervention.

Adolescent depression, as a common problem, has always been the focus of attention and research. However, no consistent conclusion has been drawn on its relationship with parental education level. Therefore, this study used meta-analysis and dose-response analysis techniques to explore the overall relationship between the two, and further explore the moderating factors affecting the relationship between the two through subgroup analysis and meta-regression analysis. After a literature search and screening, a total of 22 literatures were included, including 634,821 adolescents aged 9-25, distributed in 10 countries. The results showed that: (1) Overall parental education level was negatively correlated with adolescent depressive symptoms (RR = 0.88. p < 0.001), and there was a dose-response relationship between the two. (2) Geographical location (p = 0.002 < 0.05) and national economic development (p = 0.03 < 0.05) significantly moderated and affected the association between parental education level and adolescent depression, thus presenting a global inconsistency. The results of this study provide a more accurate conclusion on the relationship between parental education and adolescent depression to some extent, highlight the importance and necessity of considering family, economic and cultural factors when studying and solving adolescent depression problems, and guide us to pay more attention to the cross-regional and cross-cultural differences in adolescent depression problems., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Transcutaneous auricular vagus nerve stimulation (taVNS) is a crucial neuromodulation therapy for depression, yet its molecular mechanism remains unclear. Here, we aim to unveil the underlying mechanisms of antidepression by systematically evaluating the change of gene expression in different brain regions (i.e., hippocampus, anterior cingulate cortex, and medial prefrontal cortex)., Methods: The adolescent depression rat model was established by chronic unpredictable mild stress (CUMS), followed by the taVNS treatment for 3 weeks. The open field test (OFT), forced swimming test (FST), elevated plus maze test (EPM), and new object recognition (NOR) test were used to evaluate depressive- and anxiety-like behaviors. Gene expression analysis of three brain regions was conducted by RNA sequencing (RNA-seq) and further bioinformatics methods., Results: The depressive- and anxiety-like behaviors in CUMS-exposed rats were manifested by decreased spontaneous locomotor activity of OFT, increased immobility time of FST, increased entries and time in the closed arms of EPM, and decreased new object index of NOR. Furthermore, CUMS exposure also led to alterations in gene expression within the hippocampus (HIP), anterior cingulate cortex (ACC), and medial prefrontal cortex (mPFC), suggesting a potential link between adolescent stress and pathological changes within these brain regions. TaVNS could significantly ameliorate depressive- and anxiety-like behaviors. Its effects on these three brain regions were found related to regulation of the metabolism, and there were some brain region-specific findings. Compared with ACC and mPFC, taVNS has a more concrete effect on HIP by regulating the inflammation response and glycolysis., Conclusion: taVNS is capable of ameliorating adolescent depressive- and anxiety-like behaviors by regulating plenty of genes in the three brain regions. Suppressed level of inflammatory response and enhanced glycolysis manifests the dominant role of taVNS in HIP, which provides a theoretical foundation and data support for the molecular mechanism of antidepression by taVNS., (© 2024 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)

Outcome measures mostly focusing on symptom reduction to measure change cannot indicate whether any personally meaningful change has occurred. There is a need to broaden the current understanding of outcomes for adolescent depression and identify whether holistic, interlinked patterns of change may be more clinically meaningful., To create a typology of therapy outcomes based on the experiences of adolescents with depression., Interview data from 83 participants from a clinical trial of the psychological treatment of adolescent depression was analysed using ideal type analysis., Six ideal types were constructed, reflecting different evaluations of the holistic impact of therapy: "I've worked on my relationships", "With the insight from therapy, and feeling validated, I can cope with life challenges better", "My mood still goes up and down", "If I want things to change, I need to help myself", "Therapy might help, but it hasn't been enough", and "I don't feel therapy has helped me"., Assessing change using outcome measures may not reflect the interconnected experience for adolescents or the contextual meaning of symptom change. The typology developed offers a way of considering the impact of therapy, taking into account how symptom change is experienced within a broader perspective.

Background: Depressive disorder in adolescents is a major health problem with inadequate treatment. Omega-3 (ω3) polyunsaturated fatty acids are a promising adjuvant therapy in adult depression. The primary objective of this study was to investigate the efficacy of adjuvant ω3 treatment on depressive symptoms in adolescent depression. Secondarily, we explored the effects of ω3 on cognitive function and memory and niacin skin flushing response (NSFR), as their robust associations with adolescent depression., Methods: A total of 71 adolescents with depression (aged 13-24; 59.2 % female) were randomly assigned to receive ω3 plus Paxil (n = 34) or Paxil alone (n = 37) for 12 weeks. Primary outcome was depression severity according to scores on Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes were cognitive function and memory, and NSFR., Results: Significant improvements in depressive symptoms over time (p = 0.00027 at week 12) were observed in the ω3 + Paxil group compared with Paxil group. Additionally, in the ω3 + Paxil group, significant improvements in memory over time, and greater cognitive function and NSFR were also observed compared with the Paxil group; the NSFR was negatively correlated with MADRS scores at baseline., Limitations: The trial was open label; thus, the outcome measures should be viewed as preliminary since inherent bias in outcomes due to the potential of a placebo effect., Conclusions: Our results demonstrate that adjuvant ω3 treatment is effective for reducing depressive symptoms as well as improving cognitive function, memory and the NSFR; these results suggest ω3 is a promising adjuvant treatment for adolescent depression., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: In the United States, adolescent depression increased beginning in 2008-2010, coinciding with the Great Recession. We investigated whether this time of changing economic circumstances impacted adolescent depression and treatment., Methods: We analyzed data for adolescents aged 12-17 years from the 2004-2019 National Survey on Drug Use and Health (N = 256,572). Adolescents' past-year major depressive episodes (MDEs) were measured by self-reported symptoms. MDE treatment included seeing a health professional or receiving MDE medication. We tested how MDE and MDE treatment changed from pre-Great Recession (2004 to Fall 2007) to post-Great Recession (Winter 2007-2019) using interrupted time-series segmented regression models, accounting for seasonality and autocorrelation and testing for moderation by household poverty., Results: The Great Recession was not associated with an immediate increase in MDE prevalence (β:-0.77 [i.e., quarter-year change in prevalence], 95% confidence interval (CI): -2.23, 0.69). However, the increase in MDE prevalence accelerated following the Great Recession (β: 0.29, 95% CI: 0.13, 0.44). The Great Recession was not associated with immediate or long-term changes in adolescent MDE treatment (immediate β: -2.87, 95% CI: -7.79, 2.04; long-term β: 0.03, 95% CI: -0.46, 0.51). Effects were similar for households by poverty status., Discussion: The Great Recession was not associated with increased adolescent depression prevalence, although there was an acceleration in the trend of adolescent MDE following the recession. The prevalence of MDE treatment remained stable. Adolescent depression prevention efforts should be heightened as prevalence increases, including actively engaging caregivers as family supports to alleviate potential negative implications of economic distress for adolescent MDE., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Age of onset (AOO) influences the prognosis of many diseases and even serves as potential driver. But in Major Depressive Disorder, there is no consensus regarding the effect of AOO on the course., Methods: In this study, a total of 38,671 inpatients were surveyed over 16 years, and 6113 inpatients were eventually included in the statistical analysis after applying rigorous data criteria. Inpatients were divided into four AOO subgroups: adolescent onset, early adult onset, middle adult onset, and late adult onset., Results: In the subset of first hospitalization (n = 4884), the differences in the length of stay between several AOO subgroups were statistically significant (F = 56.852, df 1  = 3, df 2  = 4880, P < 0.001, ω 2  = 0.033). Similarly, this difference was also significant in the subset of relapse hospitalization (n = 1229, F = 5.985, df 1  = 3, df 2  = 1225, P < 0.001, ω 2  = 0.012). The Bonferroni post hoc test suggested a longer length of stay in the adolescent onset group (P < 0.001). Besides, in the adolescent onset subgroup, the proportion with 2 or more relapses hospitalization within one year was higher than those without relapses (6.7 % Vs 2.7 %, χ 2  = 12.685, df = 6, P < 0.001). Logistic regression suggests that patients with adolescent onset are at higher risk for 2 or more relapses hospitalization within one year (B = 0.881, OR = 2.41, 95 % CI 1.37-4.23, P = 0.002)., Limitations: Retrospective design may have recall bias., Conclusions: This is the first large sample size study to examine age at onset and risk of relapse at the individual level in a Chinese population. Our study found that adolescent onset is more susceptible to the chronicity of MDD. These findings will contribute to the accurate typing of MDD, as well as customized individualized prevention and treatment options., Competing Interests: Declaration of competing interest The authors report no declarations of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Attentional biases to emotional stimuli are thought to reflect vulnerability for mood disorder onset and maintenance. This study examined the association between the endogenous sex hormone estradiol and emotional attentional biases in adolescent females with either current or remitted depression. Three groups of participants (mean age ± SD) completed the Emotional Interrupt Task: 1) 20 adolescent females (15.1 ± 1.83 years) currently diagnosed with Major Depressive Disorder (MDD), 2) 16 adolescent females (16.4 ± 1.31 years) who had experienced at least one episode of MDD in their lifetime but currently met criteria for MDD in remission, and 3) 30 adolescent female (15.4 ± 1.83 years) healthy controls. Attentional interference (AI) scores were calculated as differences in target response reaction time between trials with emotional facial expressions versus neutral facial expressions. Estradiol levels were assayed by Salimetrics LLC using saliva samples collected within 30 min of waking on assessment days. Robust multiple regression with product terms evaluated estradiol's main effect on AI scores, as well as hypothesized estradiol × diagnostic group interactions. Although neither mean estradiol levels nor mean AI scores in the current-MDD and remitted-MDD groups differed from controls, the relationship between estradiol and overall AI score differed between control adolescents and the remitted-MDD group. Specifically, the remitted-MDD adolescents performed worse (i.e., showed greater attentional interference) when they had higher estradiol; no significant relationship existed in the current-MDD group. Because this finding was driven by angry and not happy stimuli, it appears higher estradiol levels were associated with greater susceptibility to the attention-capturing effects of negatively-valenced emotional content in girls at risk for MDD from prior history., Competing Interests: Declaration of competing interest All authors have confirmed they have no financial interests or potential conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)