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Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

The use of over-the-counter analgesics (OTCA) has been found to alter various aspects of emotional processing and has been linked to increased anxiety and depression symptoms. Attentional bias is an aspect of emotional processing that is closely related to anxiety and depression. Although OTCA and attentional bias have both been linked to anxiety and depression, the potential links between OTCA usage and attentional bias are not yet investigated. The present study aimed to determine whether the frequency of OTCA usage is associated with differences in attentional bias by comparing response-based measures of attentional bias in 62 women aged 19-30 years. The findings showed that the small group reporting high OTCA usage demonstrated more orientation avoidance to fearful stimuli than those reporting no or low usage. Based on these preliminary findings, further research on attentional bias and its relationship to high OTCA usage is recommended., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; M age = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder., (© 2024. The Author(s).)

Background: The use of over-the-counter analgesics (OTCA) is common among adolescents and has been linked with increased symptoms of anxiety and depression. However, little is known about which specific symptoms are most strongly connected to OTCA usage. The current study assessed which anxiety and depression symptoms were most closely associated with OTCA usage in a large sample of adolescents and examined whether this differed across genders., Method: The present study was based on data from 626,581 participants from the Ungdata survey in Norway. Associations between OTCA and anxiety and depression symptoms were examined using network analysis. Non-regularized partial-correlation networks were constructed to estimate the conditional dependent relations between the use of OTCA and symptoms while controlling for pain. Gender-specific networks were created for comparison., Results: OTCA usage was associated with most symptoms, even after controlling for pain, with the strongest associations with "sleep problems", "stiff or tense", "everything is a struggle" and "suddenly scared". There were some gender differences, showing that "sleep problems" and "hopeless" were more strongly related to OTCA usage in females, whereas "stiff or tense" was more strongly related to OTCA usage in males., Conclusion: Overall, the somatic symptoms of anxiety and depression displayed the strongest associations with OTCA usage. When examining the gender-specific networks, both showed similar trends, although males exhibited slightly stronger associations between OTCA usage and somatic symptoms., (© 2024. The Author(s).)

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry., (© None The Authors. Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health.)

Objective: To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation., Method: We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation., Results: We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation., Conclusions: Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.

A comprehensive understanding of skill acquisition is important for different performance domains, and has practical implications for both sport sciences and public health. The study compared important constraints for expertise development in a physically demanding sport (cross-country skiing) versus a technically demanding sport (freeskiing). Eighteen world-class athletes reported the importance of different constraints for their developmental history subdivided into two age spans: (1) 7-15 years and (2) 16 years until present. The total amount of training did not differ between the groups, but from the age of 16, the cross-country skiers spend approximately 98% of their training specific to their main sport, compared to 75% for freeskiers. No differences were found between the distribution of organized versus non-organized training in main sport, but freeskiers reported a higher amount of unorganized training in other sports after the age of 16. No differences were found in perceived importance of facilities, enjoyment of performing their sport, or the need for early specialization of training. After the age of 16, the cross-country skiers reported a higher need for coach involvement compared to freeskiers. The two sports mainly share common paths to expertise but differ in the need for specific training and coach involvement.

Background: There has been increased research interest into the concept of treatment integrity within psychotherapy research. The Competence and Adherence Scale for Cognitive Behavioural Therapy (CAS-CBT) was developed to measure therapists' competence and adherence in cognitive behavioural therapy (CBT), when delivered to children and youth with anxiety disorders., Aims: The aim of this study was to evaluate the psychometric properties of the CAS-CBT in a naturalistic treatment setting., Method: Ratings of 212 randomly selected sessions from a clinical effectiveness trial for children with anxiety disorders ( n = 165, mean age = 10.46 years, SD = 1.49) were analysed to assess the psychometric properties of CAS-CBT. Therapy format included both individual sessions and group sessions., Results: Internal consistency for the CAS-CBT was excellent (Cronbach's alpha = .88). Factor analysis suggested a two-factor solution for the total sample, where the first factor was related to CBT structure and session goals, and the second factor was associated with process and relational skills. The individual CBT treatment condition (ICBT) and group CBT treatment condition (GCBT) showed the same factor solution., Conclusion: The CAS-CBT is a feasible and reliable measure for assessing competence and adherence to CBT in the treatment of anxious children. Future research is needed to further assess the generalizability of this scale, its psychometric properties in different treatment populations and with other treatment approaches, and ideally with larger sample sizes.

Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years ( M  = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t (31.05) = -3.32, p  < .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations.

Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent's quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship., Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD., Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles., Results: At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher's exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X 2 [2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment., Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study's small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013.

Hopelessness is an important symptom of adolescent depression, being associated with both risk of suicide and poor treatment response, but predictors of hopelessness are understudied. Conflict with parents is common in adolescent depression, but parents and adolescents often disagree when reporting conflict severity. Discrepancy in reporting may be an indicator of the parent-adolescent dyad lacking a shared representation of the state of their relationship. This could make conflicts seem unresolvable to the adolescent, leading to expectations of persistent stress and lack of support, increasing hopelessness. This study employed latent difference scores, ordinal regression and cross-validation to evaluate the hypothesis that discrepancy in report of parent-adolescent conflict would predict hopelessness among depressed adolescents. Parents reporting less conflict than the adolescent was associated with increased adolescent hopelessness, giving preliminary support to the hypothesis.

Background: Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict., Objective: To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual., Methods: Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out cross-validation., Results: Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain., Conclusion: The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn., Competing Interests: Conflicts of interest The authors declare that they have no conflict of interest.

Conflict with parents is common among depressed adolescents, interferes with treatment, and may increase risk of recurrence. Parental depressive symptoms have been shown to predict conflict with adolescent children, but an important role for different kinds of parental interpersonal problems, as described by interpersonal circumplex, is also plausible. This study compared parental interpersonal problems to parental depressive symptoms as predictors of parent-adolescent conflict reported by a depressed adolescent child, using multilevel linear regression, leave-one-out cross-validation and model stacking (N = 100 parents, 57 mothers and 43 fathers, of 60 different adolescents). Cross-validation and model stacking showed that including parental interpersonal problems contributes to accurate predictions. Parents reporting more interpersonal problems related to excessive dominance or submissiveness was associated with increased or decreased conflict, respectively. Parental depressive symptoms were found to be negatively associated with parent-adolescent conflict only in father-adolescent relationships.

Objective: Identifying factors associated with early treatment response is important, because it can help allocate limited resources in psychiatric care more appropriately. This study examined baseline characteristics of participants with early response to exposure-based cognitive behavior therapy (CBT) for pediatric obsessive-compulsive disorder (OCD)., Method: 269 participants with OCD, aged 7-17 years, were enrolled in a 14-weeks CBT program. We identified participants with early response to treatment, (CY-BOCS total score of ≤15), by the seventh session., Results: At week 7, 248 (92.2%) participants were assessed, 38.3% (95% CI 32.4-44.5%, n = 95) were identified as treatment responders. Univariate analyses showed that six baseline characteristics were significantly associated with early treatment response: young age, lower levels of symptom severity, functional impairment, internalizing- and externalizing problems, depressive symptoms, and family accommodation., Conclusions: These results suggested that treatment plans for younger children with moderate OCD symptoms and no major comorbid disorder should include briefer and less resource demanding treatment formats than the commonly recommended and applied standard doses of 15 CBT sessions., (Copyright © 2019 Elsevier B.V. All rights reserved.)