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Adolescent depression in skipped-generation families is a growing concern, yet the role of grandparenting styles and gender attitudes remains understudied. Data from 1,039 adolescents (511 girls, 528 boys) in rural Chinese skipped-generation families were analyzed. Mediation analyses examined associations between grandparenting styles, gender attitudes, and depression. Higher grandparental rejection correlated with higher depression (Estimate =.35, p <.001), while higher emotional warmth correlated with lower depression (Estimate = −.32, p <.001). Emotional warmth was associated with more egalitarian gender attitudes (Estimate =.12, p <.001). Gender attitudes partially mediated the association between emotional warmth and depression among girls, but not boys. A significant gender difference was found in the association between gender attitudes and depression (p <.05). Grandparenting styles and gender are associated with depression in adolescents from skipped-generation families. Mental health interventions should focus on educating grandparents to provide emotional support and promoting egalitarian gender attitudes, especially among girls. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of this study is to examine the association between childhood material hardship and adolescent depression and how the relationship is mediated by neighborhood social cohesion and trust. Previous studies on childhood material hardship and adolescent depression have consistently pointed to the importance of social and environmental contexts in explaining health inequalities among children in socially disadvantaged families. However, little is known about the extent to which neighborhood social context contributes to increasing or decreasing the strength of the association between childhood material hardship and adolescent depression.MethodUsing data from the Future of Families and Child Wellbeing Study (FFCWS) waves 3 and 6, this study conducted Structural Equation Modeling (SEM) analysis to examine whether levels of neighborhood social cohesion and trust mediates the association between childhood material hardship and adolescent depression. The study sample consisted of 2,096 children at age 3 and 15.ResultsFindings from the SEM analysis suggest that childhood material hardship is linked with higher levels of adolescent depression and this pathway is partially mediated by neighborhood social cohesion and trust.DiscussionResults suggest that neighborhood conditions played a role in mediating the association between childhood material hardship and adolescent depression. The implications of the findings are discussed in relation to policy and practice.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

PURPOSE: Children of mothers with prenatal depression have elevated risk for depression later in life. Pregnant women are hesitant to use antidepressants due to fear of adverse fetal effects. To inform prevention, this study examined associations between maternal prenatal depression and antidepressant use, and adolescent depressive symptoms and suicidality. PATIENTS AND METHODS: Prospective data from 74,695 mother-adolescent dyads from the Kaiser Permanente Northern California integrated healthcare delivery system were used. Three prenatal exposure groups were examined: maternal depression and antidepressants (Med); depression and no antidepressants (No-Med); neither depression nor antidepressants (NDNM). Adolescent depressive symptoms (Patient Health Questionnaire-2 score ≥3) and suicidality were assessed for 12- to 18-year-olds. Associations were analyzed using mixed effects logistic regression, adjusted for confounders. RESULTS: Maternal prenatal depression was associated with higher odds of adolescent depressive symptoms (Med odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.23-1.84; No-Med OR: 1.59, CI: 1.34-1.88) and suicidality (Med OR: 2.36, CI: 1.67-3.34; No-Med OR: 1.54, CI: 1.10-2.14) compared to no prenatal depression (NDNM). Adolescents exposed to prenatal depression and antidepressants were not at greater odds of depressive symptoms (Med OR: 0.95, CI: 0.74-1.21) compared to those not exposed to antidepressants (No-Med). However, they showed non-significant but greater odds of suicidality (Med OR: 1.54, CI: 0.99-2.39). CONCLUSION: Our findings suggest that maternal prenatal depression is associated with adolescent depressive symptoms and suicidality, and that exposure to antidepressants in utero does not increase risk of depressive symptoms, specifically. While not statistically significant, the increased odds of suicidality among adolescents exposed to antidepressants suggest a possible association; however, further investigation is needed. After replication, the findings of this study may inform shared clinical decision-making when considering options regarding antidepressant use for the treatment of maternal prenatal depression.

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. [ABSTRACT FROM AUTHOR]

Devora Beck-Pancer,1,2 Sara Aghaee,3 Alysia Swint,1,4 Julia Acker,1 Julianna Deardorff,1,3,&ast; Ai Kubo3,&ast; 1School of Public Health, University of California, Berkeley, CA, USA; 2School of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 4School of Medicine, George Washington University, Washington, DC, USA&ast;These authors contributed equally to this workCorrespondence: Devora Beck-Pancer, UCSF School of Medicine, 513 Parnassus Ave., Suite S-245, San Francisco, CA, 94143-0454, USA, Email d.beck-pancer@ucsf.eduPurpose: Children of mothers with prenatal depression have elevated risk for depression later in life. Pregnant women are hesitant to use antidepressants due to fear of adverse fetal effects. To inform prevention, this study examined associations between maternal prenatal depression and antidepressant use, and adolescent depressive symptoms and suicidality.Patients and Methods: Prospective data from 74,695 mother-adolescent dyads from the Kaiser Permanente Northern California integrated healthcare delivery system were used. Three prenatal exposure groups were examined: maternal depression and antidepressants (Med); depression and no antidepressants (No-Med); neither depression nor antidepressants (NDNM). Adolescent depressive symptoms (Patient Health Questionnaire-2 score ≥ 3) and suicidality were assessed for 12- to 18-year-olds. Associations were analyzed using mixed effects logistic regression, adjusted for confounders.Results: Maternal prenatal depression was associated with higher odds of adolescent depressive symptoms (Med odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.23– 1.84; No-Med OR: 1.59, CI: 1.34– 1.88) and suicidality (Med OR: 2.36, CI: 1.67– 3.34; No-Med OR: 1.54, CI: 1.10– 2.14) compared to no prenatal depression (NDNM). Adolescents exposed to prenatal depression and antidepressants were not at greater odds of depressive symptoms (Med OR: 0.95, CI: 0.74– 1.21) compared to those not exposed to antidepressants (No-Med). However, they showed non-significant but greater odds of suicidality (Med OR: 1.54, CI: 0.99– 2.39).Conclusion: Our findings suggest that maternal prenatal depression is associated with adolescent depressive symptoms and suicidality, and that exposure to antidepressants in utero does not increase risk of depressive symptoms, specifically. While not statistically significant, the increased odds of suicidality among adolescents exposed to antidepressants suggest a possible association; however, further investigation is needed. After replication, the findings of this study may inform shared clinical decision-making when considering options regarding antidepressant use for the treatment of maternal prenatal depression.Keywords: prenatal depression, adolescent depression, intergenerational depression, antidepressants, mental health, maternal health

BackgroundHigh rates of adolescent depression demand for more effective, accessible treatment options. A virtual randomized controlled trial was used to assess the feasibility and acceptability of a 5-week, self-guided, cognitive behavioral therapy (CBT)-based mobile application, Spark, compared to a psychoeducational mobile application (Active Control) as an adjunct treatment for adolescents with depression during the COVID-19 pandemic.MethodsA community sample aged 13–21, with self-reported symptoms of depression, was recruited nationwide. Participants were randomly assigned to use either Spark or Active Control (NSpark = 35; NActive Control = 25). Questionnaires, including the PHQ-8 measuring depression symptoms, completed before, during, and immediately following completion of the intervention, evaluated depressive symptoms, usability, engagement, and participant safety. App engagement data were also analyzed.Results60 eligible adolescents (female = 47) were enrolled in 2 months. 35.6% of those expressing interest were consented and all enrolled. Study retention was high (85%). Spark users rated the app as usable (System Usability Scalemean = 80.67) and engaging (User Engagement Scale-Short Formmean = 3.62). Median daily use was 29%, and 23% completed all levels. There was a significant negative relationship between behavioral activations completed and change in PHQ-8. Efficacy analyses revealed a significant main effect of time, F = 40.60, p

BackgroundAdolescent anxiety and depression are highly prevalent psychiatric disorders that are associated with altered molecular and neurocircuit profiles. Recently, increased mitochondrial DNA copy number (mtDNA-cn) has been found to be associated with several psychopathologies in adults, especially anxiety and depression. The associations between mtDNA-cn and anxiety and depression have not, however, been investigated in adolescents. Moreover, to date there have been no studies examining associations between mtDNA-cn and brain network alterations in mood disorders in any age group.MethodsThe first aim of this study was to compare salivary mtDNA-cn between 49 depressed and/or anxious adolescents and 35 well-matched healthy controls. The second aim of this study was to identify neural correlates of mtDNA-cn derived from diffusion tensor imaging (DTI) and tractography, in the full sample of adolescents.ResultsThere were no diagnosis-specific alterations in mtDNA-cn. However, there was a positive correlation between mtDNA-cn and levels of anxiety, but not depression, in the full sample of adolescents. A subnetwork of connections largely corresponding to the left fronto-occipital fasciculus had significantly lower fractional anisotropy (FA) values in adolescents with higher than median mtDNA-cn.LimitationsUndifferentiated analysis of free and intracellular mtDNA and use of DTI-based tractography represent this study's limitations.ConclusionsThe results of this study help elucidate the relationships between clinical symptoms, molecular changes, and neurocircuitry alterations in adolescents with and without anxiety and depression, and they suggest that increased mtDNA-cn is associated both with increased anxiety symptoms and with decreased fronto-occipital structural connectivity in this population.

The bidirectional associations between maternal depression and child psychological functioning are generally well-established. Paternal depression may also share some bidirectional associations with child psychological functioning, but there is limited research in this area. It is unclear how or when one family member's anxiety or depression might affect another family member's mental health. The present study tested the bidirectional associations between maternal depression, paternal depression, and children's internalizing problems of anxiety and depression from early childhood into mid-adolescence. The present study also included unmarried parents, who are often underrepresented in research. Secondary analyses were performed using a subset of data from the Fragile Families and Child Wellbeing (FFCW) study, beginning when children were 3-years-old and ending when children were 15-years-old. Families (N = 4,873) were from racially and economically diverse backgrounds-nearly half of the mothers were non-Hispanic Black and 65% of mothers had a high school degree or further education. We found evidence of bidirectional associations between maternal depression and child internalizing problems across early childhood and into adolescence. We found no bidirectional associations between paternal and maternal depression or between paternal depression and children's internalizing problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. [ABSTRACT FROM AUTHOR]

Learning objectives: After completing this activity, practitioners will be better able to: • Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine" • Set up a process for providing effective interventions for the increased number of patients with adolescent depression • Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications. [ABSTRACT FROM AUTHOR]

There are known disparities in the burden of illness and access/quality of care for African, Latino/a, Asian, and Native American (ALANA) patients diagnosed with depressive disorders, which may occur because of health inequities. Racial stress and trauma (RST), or the significant fear and distress that can be imparted from exposure to racism, is one such inequity linked to the development of depression. The current review summarizes past research examining the association between racism, RST, and depression, as well as avenues in which RST becomes biologically embedded in ALANA individuals. We describe multimodal research that supports vigilance as a potential mediator of the association between RST and depression and consider the nuanced role that vigilance plays during experiences with racism. Finally, we describe methodological advances in the assessment of vigilance evoked by RST and the clinical implications that may be generated by future improvements. In each of these areas, we present examples of how ongoing and future research can be leveraged to provide support for psychosocial programs that facilitate autonomous community healing and resilience, increase calls for public policy changes, and support clinical interventions that lessen the burden of racism on ALANA communities. [ABSTRACT FROM AUTHOR]

Children of maternal caregivers abused in childhood are at increased risk for mental health problems including anxiety and depression. To date, most studies exploring the intergenerational transmission of trauma have focused on younger children, with far fewer studies investigating adolescent mental health. Previous research suggests that maternal childhood abuse negatively impacts the parent–adolescent relationship, which may contribute to the development and maintenance of adolescent mental health problems. The current study examined dyadic reports of maternal–adolescent relationship quality as mediators linking maternal reports of childhood abuse to adolescent depression and anxiety. The bootstrapped indirect effects from maternal childhood abuse to adolescent symptoms of anxiety and depression were significant through adolescent reports of relationship quality, but not through maternal reports of relationship quality. Findings suggest that an adolescent's perception of their maternal–adolescent relationship may mediate the relationship between their maternal caregiver's childhood abuse and their own symptoms of anxiety and depression. [ABSTRACT FROM AUTHOR]

BackgroundThe novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in adolescent depression and framed within the National Institute of Mental Health Research Domain Criteria. TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills, and value-based committed action.MethodsWe performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing depression and anxiety levels and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six adolescents (14-18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1), and 3 months after the end of TARA (T2).ResultsSignificant improvement was seen in depression symptoms (Reynolds Adolescent Depression Scale Second Edition) between T0-T1 (t-value = -3.56, p = 0.002, CI = -6.64, -1.77) and T0-T2 (t-value = -4.17, p

AimsClose to one third of patients with major depression show increases in pro-inflammatory cytokines, which are in turn associated with risk for inflammatory disease. Genetic variants that enhance immune reactivity may thus enhance inflammatory and depressive reactions to stress. The aim of the present study was to investigate a trio of functional SNPs in the promoter regions of IL6 (-174G>C, rs1800795), IL1β (-511C>T, rs16944), and TNF (-308G>A, rs1800629) as moderators of the relationship between chronic stress exposure and elevations in depressive symptoms.MethodsParticipants were 444 Australian youth (mean age=20.12) whose exposure to chronic stress in the past 6months was assessed using the semi-structured UCLA Life Stress Interview, and who completed the Beck Depression Inventory II at ages 15 and 20. Between ages 22 and 25, all participants in the selected sample provided blood samples for genotyping.ResultsIn line with a hypothesized moderation effect, -174G allele carriers at IL6 had fewer depressive symptoms following interpersonal stress, relative to C/C homozygotes with equal interpersonal stress exposure. However, IL6 genotype did not moderate the effects of non-interpersonal stress exposure (i.e., financial, work and health-related difficulties) on depression. Also in line with hypotheses, the -511C allele in IL1β, previously associated with higher IL-1β expression, was associated with more severe depression following chronic interpersonal stress exposure, relative to T/T homozygotes. Again, the moderating effect was specific to interpersonal stressors and did not generalize to non-interpersonal stress. TNF was not a moderator of the effects of either interpersonal or non-interpersonal stress on later depression outcomes.ConclusionFindings were consistent with the hypothesis that pro-inflammatory genetic variation increases the risk of stress-induced depression. The present results provide evidence of a genetic mechanism contributing to individual differences in depressive symptomatology following interpersonal stress exposure.

BackgroundThe subgenual anterior cingulate cortex (sgACC) and its connected circuitry have been heavily implicated in emotional functioning in adolescent-onset major depressive disorder (MDD). While several recent studies have examined sgACC functional connectivity (FC) in depressed youth at rest, no studies to date have investigated sgACC FC in adolescent depression during negative emotional processing.MethodsNineteen medication-naïve adolescents with MDD and 19 matched healthy controls (HCL) performed an implicit fear facial affect recognition task during functional magnetic resonance imaging (fMRI). We defined seeds in bilateral sgACC and assessed FC using the psychophysiological interaction method. We also applied cognitive behavioral modeling to estimate group differences in perceptual sensitivity in this task. Finally, we correlated connectivity strength with clinical data and perceptual sensitivity.ResultsDepressed adolescents showed increased sgACC-amygdala FC and decreased sgACC-fusiform gyrus, sgACC-precuneus, sgACC-insula, and sgACC-middle frontal gyrus FC compared to HCL (p

Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8-20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression - Training for Awareness, Resilience, and Action (TARA) - that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.

Growing economic inequality across the family and school contexts that adolescents inhabit may have significant consequences for their psychological well-being. Yet little research has assessed the mental health repercussions of economic inequities or whether such repercussions have shifted with rising inequality. This study assessed annual Monitoring the Future surveys with 8th (n = 124,468; age 13; 59 percent White, 41 percent students of color), 10th (n = 164,916; age 15; 65 percent white, 35 percent students of color), and 12th (n = 60,664; age 17; 66 percent white, 34 percent students of color) grade students from 1989–2017. Analyses tracked secular trends in adolescent depressive symptoms and assessed whether family and school socioeconomic status (SES) disparities in depressive symptoms have shifted over time. Depressive symptoms showed significant elevations in 2014–2017 among 8th, 10th, and 12th graders over 2010–2013 levels. Pervasive small SES gaps were found in adolescent depressive symptoms, with youth from lower SES families and lower SES schools reporting higher depressive symptoms than their more advantaged peers across all grades. Family SES gaps remained stable over recent decades, whereas school SES gaps rose significantly in recent years across all grades and genders, suggesting that the recent rise in depressive symptoms is driven by adolescents in low SES schools. The results suggest that repercussions of growing economic inequality may extend to psychological outcomes, and identify the need for greater preventive and intervention services targeting adolescent mental health. [ABSTRACT FROM AUTHOR]

We introduce this supplemental issue of Prevention Science, which brings together a set of papers from leading investigators who have conducted trials testing whether intervention programs prevent adolescent depression. Using data from these trials, these papers explore a series of factors that might account for variation in intervention benefit, employing several novel methods for assessing effect heterogeneity. These studies follow two general paradigms: three papers report findings from single randomized preventive intervention trials, while the remaining papers develop and apply new methods for combining data from multiple studies to evaluate effect heterogeneity more broadly. Colleagues from NIMH and SAMHSA also provide commentaries on these studies. They conclude that synthesis of findings from multiple trials holds great promise for advancing the field, and progress will be accelerated if collaborative data sharing becomes the norm rather than the exception. [ABSTRACT FROM AUTHOR]

Adolescent depression is a silent epidemic in this country. Untreated depression has detrimental effects on physical health, psychosocial well-being, and academic productivity. It is important for school nurses to be able to recognize depression and refer students promptly for treatment. This article and its associated learning module will provide school nurses with updated information on adolescent depression, discuss barriers in depression screening, use of the PHQ-9 (Patient Health Questionaire-9 Item) as an evidence-based depression screening tool in the educational setting, and the important role of school nurses in depression screening. It is anticipated that by increasing awareness and knowledge about adolescent depression and providing training in the use of an evidence-based screening tool, school nurses will have greater confidence in identifying and referring students in need. (A free online depression screening education module developed by the lead author is available at https://sites.google.com/view/depressionscreeningtraining.) [ABSTRACT FROM AUTHOR]

Emotion regulation has been implicated in the etiology of depression. A first step in adaptive emotion regulation involves emotional clarity, the ability to recognize and differentiate one's emotional experience. As family members are critical in facilitating emotional understanding and communication, we examined the impact of family functioning on adolescent emotional clarity and depressive symptoms. We followed 364 adolescents (ages 14-17; 52.5% female; 51.4 % Caucasian, 48.6% African American) and their mothers over 2 years (3 time points) and assessed emotional clarity, depressive symptoms, and adolescents' and mothers' reports of family functioning. Emotional clarity mediated the relationship between adolescents' reports of family functioning and depressive symptoms at all time points cross-sectionally, and according to mothers' reports of family functioning at Time 1 only. There was no evidence of longitudinal mediation for adolescents' or mothers' reports of family functioning. Thus, family functioning, emotional clarity, and depressive symptoms are strongly related constructs during various time points in adolescence, which has important implications for intervention, especially within the family unit. [ABSTRACT FROM AUTHOR]

A significant number of adolescents experience depression and other mental health disorders that may put them at risk for suicide. Mental health assessment is an important component of primary healthcare. Depression and suicide risk screening can assist healthcare providers in preventing suicides. [ABSTRACT FROM AUTHOR]

Prior research has identified reduced reward-related brain activation as a promising endophenotype for the early identification of adolescents with major depressive disorder (MDD). However, it is unclear whether reduced reward-related brain activation constitutes a true vulnerability for MDD. One way of studying vulnerability is through a high-risk design. Therefore, the aim of the current study was to determine whether reward-related activation of the ventral striatum is reduced in nondepressed daughters of mothers with a history of MDD (high-risk) similarly to currently depressed adolescent girls, compared with healthy controls. By directly comparing groups with a shared risk profile during differing states, we aimed to shed light on the endophenotypic nature of reduced reward processing for adolescent depression. We compared reward-related neural activity through functional magnetic resonance imaging (fMRI) between three groups of female biological offspring {N = 52) of mothers with differential MDD status: (a) currently depressed daughters of mothers with a history of MDD (MDD group; n = 14), (b) age- and socioeconomic status (SES)-matched never-depressed daughters of mothers with a history of MDD (high-risk group; n = 19), and (c) age- and SES-matched control daughters of mothers with no past or current psychopathology in either the mother or the daughter (healthy control group; n = 19). For the outcome phase of the reward task, right-sided ventral striatum activation was reduced for both currently depressed and high-risk girls compared with healthy controls. This ventral striatal activity correlated significantly with maternal depression scores. These findings provide further evidence of aberrant functioning for the United States Department of Health & Human Services, National Institutes of Health, National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC)-defmed domain of positive valence systems as a vulnerability factor for MDD and a potential endophenotype for the development of depression. [ABSTRACT FROM AUTHOR]

This article explores the implications of maternal roles for adolescent depression by developing a theoretical model linking the gendered ideologies and work and family roles of mothers to the depression of their adolescent children. The model posits that incongruity between mothers' roles and their ideologies concerning maternal roles results in maternal distress, which influences their parenting in ways that ultimately affect adolescent depression. We test this model using data from the National Survey of Children and covariance structure analysis. The results support the theoretical arguments, demonstrating that incongruity between mothers' roles and ideologies influences family processes in ways relevant for understanding the depression of adolescents. [ABSTRACT FROM AUTHOR]

Youth who have mental health issues are more likely than their peers to seek primary care services. The primary care setting is an appropriate venue for screening and identifying pediatric depression. Additionally, nurse practitioners can provide initial management or referral to psychiatric mental health professionals for evidence-based treatments. [ABSTRACT FROM AUTHOR]

Background: There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms. Methods: The total population of 16-17-year-olds in Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later. Results: Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders. Conclusions: Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms. [ABSTRACT FROM AUTHOR]

This manuscript focuses on qualitative data collected for AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. Data are presented from our phase I study of adult perspectives on African American adolescent depression, depression treatment, and research engagement. The research team conducted four focus groups ( N = 24) and generated major themes from the data including ideas regarding the manifestations of depression in African American youth and psychosocial barriers to participation in depression research and treatment. Findings indicate that success in recruiting and retaining African American youth in depression research and treatment may include using innovative means to overcome the culturally embedded attributions of depression to non-biological causes, beliefs about the cultural insensitivity of treatments and challenges in the logistics of obtaining care. Adults report that encouraging youth and familial involvement in treatments and research should include targeted, community-partnered activities involving diverse staff in leadership roles and including community members as equal partners. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent studies have highlighted the unfavourable natural course of chronic/long-term depression. We investigated the adult mental health outcome of adolescent depression, with specific focus on long-term and episodic adolescent major depression (MD). Methods: A community sample of depressed adolescents and non-depressed peers was followed-up with a structured diagnostic interview after 15years. The participants (n=382) were divided into five groups depending on their status in adolescence: no depression (n=155); long-term MD (n=91); episodic MD (n=63); dysthymia (n=33); and subthreshold symptoms (n=40). Outcomes (age 19–31) included mood disorders, other mental disorders, suicidality, and treatment for mental disorders. Results: The long-term group overall had a poorer outcome than the non-depressed group, with the episodic group in an intermediate position. The outcome of the dysthymic group was similar to that of the long-term group, while the subsyndromal group did not differ markedly from the non-depressed group. The long-term group was more likely than the episodic group to report adult anxiety disorders, multiple mental disorders, suicide attempts, and treatment; they also seemed to develop more persistent adult depressions, with a higher number of recurrent episodes and longer duration of antidepressant treatment. Even after adjustment for adolescent factors of clinical and etiological importance, the long-term group had a markedly less favourable outcome than the episodic group. Limitation: The participation rate at follow-up was 64.6%. Conclusion: Longstanding depression in adolescence is a powerful predictor of continued mental health problems in adulthood. It is now important to evaluate if early interventions can alter this severe course. [Copyright &y& Elsevier]

The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents' experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1–12, 2010. [ABSTRACT FROM AUTHOR]

This paper addresses the phenomenology of childhood depression as understood from the perspective of psychoanalytic child psychotherapy within National Health Service (NHS) practice. Brief time-limited psychotherapy has a promising outcome in working with severely depressed young people when combined with support for parents and careful attention to the child's social and educational context. The currently planned IMPACT study (Improving Mood-Promoting Access to Collaborative Treatment) led by Professor I. Goodyer will provide an opportunity to explore both the effectiveness of short-term therapy for a large cohort of moderate to severely depressed youngsters and also to research models of underlying mental processes and some of the processes of change in psychotherapy (Fonagy, 2009; Rustin, 2009). Child psychotherapy theory and practice is rooted in both psychoanalytic and developmental frames of reference and has been deeply influenced by Bowlby's work. The importance of aggression and particularly aggressive thoughts, both conscious and unconscious, in understanding depression is also fundamental. Two clinical cases are discussed which are typical of those patients seen in NHS child psychotherapy, and of the type of patients who will be seen in the IMPACT trial. They share serious adverse life histories: one with a focus on childhood abuse and the other on neglect and abandonment. The different nature of these traumatic experiences shapes the nature of the depression which can be observed. The importance of attending to the depressive elements of the co-morbid presentation characteristic of Child and Adolescent Mental Health Services (CAMHS) patients also needs to be emphasized. Psychotherapy provides an opportunity for containment of unbearable emotion and for the development of mental function which can serve as a bulwark against further breakdown. The conceptualization draws attention to the loss of personal potency which accompanies depression and the consequent risk of life failure in both work and personal spheres. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: There are significant racial/ethnic disparities in youth access to and use of appropriate depression treatment. Although there is a growing literature on racial/ethnic differences in treatment preference among adults, we know very little about whether these differences persist for adolescents and whether parents have an influence on their teens¿ treatment perspectives. Methods: Teens and parents from a sample of primary care settings were interviewed at baseline and 6 months. We used bivarate and regression analyses to describe racial/ethnic differences in teen and parent depression knowledge and treatment preference and to assess the impact of parental views on teen perspectives. Results: Latino and African American teens had lower average scores on antidepressant knowledge (p < .01) and counseling knowledge than white teens (p < .01). These racial/ethnic differences were greater among parents (p < .001). Parent antidepressant knowledge had an impact on teen knowledge when teens reported turning to them for advice (¿ = 0.20, p < .05). Teen knowledge about medication (odds ratio [OR] = 1.16, p < .01) and counseling (OR = 1.26, p < .001) were associated with a willingness to seek active treatment. Conclusions: Racial/ethnic differences in depression treatment knowledge persist, but are more pronounced for parents than teens. Talking to parents who have more knowledge about depression treatment is associated with more teen knowledge and that knowledge is associated with greater willingness to seek depression treatment. Research is needed on the content and type of conversations that parents and teens have about depression treatment, and if there are differences by race/ethnicity. [Copyright &y& Elsevier]

Abstract: This article reviews typical symptoms of depression presented by adolescents in the reproductive care practice setting, provides an overview of the assessment process, and offers options for referral and/or treatment of this common, yet often unrecognized, mood disorder. Because females have a two-fold higher prevalence rate of depressive disorders as compared to males of the same age and because reproductive care providers have exceptional access to females during the early reproductive years, these physicians have a unique, but often unrealized, opportunity to detect and initiate treatment and/or referrals for depression in adolescent patients. Indeed, adolescents often discuss symptoms of depression with their reproductive care provider with an expectation that they will serve as a “first responder” in terms of assisting in the management of the depression. Thus, it is important that the provider have an understanding of the disorder, its symptoms, and possible treatment modalities. Reproductive care providers are uniquely qualified to identify, assess, and treat many types of mood disorders in adolescent females. [Copyright &y& Elsevier]

In this article I review the changes in thinking about childhood depression since the 1950s, with an emphasis on the struggles to find language for child- hood depression. My interface with these changes is described, with a particular focus on the development of the Children's Depression Scale (CDS). Clinical applications of family therapy using the CDS in treatment of childhood depression are then illustrated with a composite case example. The idea is developed that depression in children can be seen as a blocked communication, and that increasing emotional expressiveness in families is an appropriate therapeutic aim and intervention. The relevance of the historical context to current practice is considered. [ABSTRACT FROM AUTHOR]

Background: Studies using traditional SES indicators in strictly adolescent populations have usually failed to find class differences in adolescent mental health. The present study aimed to find out whether there is an association between adolescent perceived financial difficulties of the family and adolescent maladjustment, and to explore the possible sex differences in this association. Methods: School-based survey on 3278 ninth grade students (15-16 years old) in two economically well developed Finnish cities. Results: One-fifth of the adolescents reported that their family had financial difficulties in the previous 12 months. Perceiving financial difficulties was significantly more common among girls than boys. Perceived financial difficulties were associated with known risk factors of poverty and with depression and harmful drinking patterns in both sexes. Adjusting for parental educational levels, parental unemployment and family structure did not change the significant association with maladjustment outcomes. Additional adjustment with comorbidity, however, levelled out the significance of the association of perceived financial difficulties and harmful drinking patterns in boys. Conclusion: While adolescent perception of financial difficulties is probably associated with the objective financial situation of the family it may also be an indicator of the psychological meaning attached to the situation and should thus be considered a possible risk factor for adolescent maladjustment in clinical practice. [ABSTRACT FROM AUTHOR]

Researchers have documented health disparities for African American and other youth of color in the area of mental health. In accordance with calls for the development of innovative methods for use in reducing these disparities, the purpose of this article is to describe the development of an evidence-based intervention targeting the use of psychiatric clinical care by African American families.The authors summarize current research in the areas of perceived and demonstrated bias in the provision of mental health services, the significance of the problem of low African American participation in psychiatric clinical research and care, and evidence-based approaches to conducting family-oriented research to address adolescent mental illness in this population. This discussion is followed by a description of the development of an intervention to improve familial treatment engagement and plans to test the intervention. The article is provided as a foundation for carefully defined plans to address the unmet mental health needs of depressed African American adolescents within a culturally relevant familial context. [ABSTRACT FROM AUTHOR]

Previous research has documented an association between adolescent community violence exposure (CVE) and poor psychological functioning. The purpose of this study is to delineate the relations of CVE, parental mental health, and adolescent PTSD and depression. Participants consisted of 121 pairs of junior high and high school students and their parents. Adolescents completed measures to assess their history of violence exposure and current psychological functioning. Parents completed a demographic questionnaire and measures assessing their psychological functioning. Hierarchical regression analyses were conducted, and results indicated that, after controlling for demographic variables and family violence exposure, parental mental health emerged as a moderating variable in the relation between CVE and adolescent-rated PTSD, but not in the association between adolescent CVE and depression. Clinical implications of this study and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population. [ABSTRACT FROM AUTHOR]