Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood

Gobbi,  G. et al.| 2019|  Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young AdulthoodA Systematic Review and Meta-analysis| JAMA Psychiatry| Published online February 13, 2019| doi:10.1001/jamapsychiatry.2018.4500

JAMA Psychiatry has published a systematic review and meta-analysis that examined if there was an association between cannabis use as a young person and the risk of depression, anxiety and suicidality between the ages of 18 and 32.

Question  Is adolescent cannabis consumption associated with risk of depression, anxiety, and suicidality in young adulthood?

 

Findings  In this systematic review and meta-analysis of 11 studies and 23 317 individuals, adolescent cannabis consumption was associated with increased risk of developing depression and suicidal behavior later in life, even in the absence of a premorbid condition. There was no association with anxiety.

Meaning  Preadolescents and adolescents should avoid using cannabis as use is associated with a significant increased risk of developing depression or suicidality in young adulthood; these findings should inform public health policy and governments to apply preventive strategies to reduce the use of cannabis among youth.

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Abstract

Importance  Cannabis is the most commonly used drug of abuse by adolescents in the world. While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood.

Objective  To provide a summary estimate of the extent to which cannabis use during adolescence is associated with the risk of developing subsequent major depression, anxiety, and suicidal behavior.

Data Sources  Medline, Embase, CINAHL, PsycInfo, and Proquest Dissertations and Theses were searched from inception to January 2017.

Study Selection  Longitudinal and prospective studies, assessing cannabis use in adolescents younger than 18 years (at least 1 assessment point) and then ascertaining development of depression in young adulthood (age 18 to 32 years) were selected, and odds ratios (OR) adjusted for the presence of baseline depression and/or anxiety and/or suicidality were extracted.

Data Extraction and Synthesis  Study quality was assessed using the Research Triangle Institute item bank on risk of bias and precision of observational studies. Two reviewers conducted all review stages independently. Selected data were pooled using random-effects meta-analysis.

Main Outcomes and Measures  The studies assessing cannabis use and depression at different points from adolescence to young adulthood and reporting the corresponding OR were included. In the studies selected, depression was diagnosed according to the third or fourth editions of Diagnostic and Statistical Manual of Mental Disorders or by using scales with predetermined cutoff points.

Results  After screening 3142 articles, 269 articles were selected for full-text review, 35 were selected for further review, and 11 studies comprising 23 317 individuals were included in the quantitative analysis. The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37. The pooled OR for anxiety was not statistically significant: 1.18. The pooled OR for suicidal ideation was 1.50.

Conclusions and Relevance  Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.

Source: JAMA Pyschiatry

This article is available to Rotherham NHS staff  and can be requested here 

In the news:

The Telegraph Smoking cannabis as teenager increases risk of depression by 40 per cent, Oxford study finds

BBC News Cannabis use in teens linked to depression

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NICE: Offer digital CBT to young people with mild depression

NICE |  January 2019 | Offer digital CBT to young people with mild depression, says NICE

Children and young people can be offered digital cognitive behavioural therapy (digital CBT, also known as computer CBT) as a first-line treatment for mild depression, says NICE. Currently digital CBT is recommended for adults with mild to moderate depression. 

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NICE says that the choice of treatment should be based on clinical need and patient and carer preferences. The child or young person’s history, circumstances and maturity should also be considered.

Digital CBT is delivered on mobile phones, tablets or computers, meaning users can access help quickly, avoiding waiting lists.

This draft recommendation is made in a fast-tracked update to NICE’s existing guideline on depression in children and young people aged 5 to 18. It follows a recent trial (published in The Lancet)  which showed the benefits young people can gain from psychological therapies.

Digital CBT is already recommended for adults with mild to moderate depression (Source: NICE)

Read the full news story from NICE Offer digital CBT to young people with mild depression, NICE says 

See NICE Depression in children and young people: identification and management

See also:

The Lancet Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial 

Does Emotional Intelligence Mediate the Relationship Between Mindfulness and Anxiety and Depression in Adolescents?

Stough, C., Foster, B., Lomas, J. E., & Downey, L. A. |2018| Does Emotional Intelligence Mediate the Relationship Between Mindfulness and Anxiety and Depression in Adolescents?|  Frontiers in Psychology| 9| 2463.

Does Emotional Intelligence Mediate the Relationship Between Mindfulness and Anxiety and Depression in Adolescents? Is one of the questions asked a new study to examine if the development of emotional intelligence (EI) is one mechanism by which mindfulness confers its benefits on wellbeing. The research considers and examines the relationship between mindfulness, EI, anxiety and depression in an adolescent population.

 

High anxiety and depression are often observed in the Australian adolescent population, and if left untreated, can have long-term negative consequences impacting educational attainment and a range of important life outcomes. The utilization of mindfulness techniques has been associated with decreased anxiety and depression, but the underlying mechanisms for this is only beginning to be understood. Previous research with adult samples has suggested that the development of emotional intelligence (EI) may be one mechanism by which mindfulness confers its benefits on wellbeing. This study is the first to examine the relation between mindfulness, EI, anxiety and depression in an adolescent population. It was hypothesised that EI would mediate the relationships between mindfulness and anxiety, as well as mindfulness and depression. The sample consisted of 108 adolescents from a public secondary school, aged between 13 and 15 years (Mage = 13.68, SDage = 0.56, 51 males and 57 females). Participants completed an online self-report questionnaire which measured dispositional mindfulness, EI, anxiety and depression. The results indicated that one subscale of EI – Emotional Recognition and Expression (ERE) mediated the relation between mindfulness and anxiety, while two subscales of EI – ERE and Emotional Management and Control (EMC) mediated the relation between mindfulness and depression. Future research utilising a mindfulness intervention should be conducted to examine whether the use of mindfulness increases EI and decreases anxiety and depression in adolescents (Soruce; Frontiers in Pyschology) .

The article has been released ahead of the article’s publication- further details from Frontiers in Psychology.

New study finds parents and teachers struggle to recognise symptoms of depression in children and young people

A new study from University of  Missouri-Columbia examined how patterns between student, teacher and parent reporting could be used to create a fuller picture of the child’s mental health. The researchers completed profile analyses of 643 school aged children (between the ages of 6 and 12). They found that while almost a third (30 per cent) of children in the study reported feeling mildly to severely depressed, parents and teachers often failed to recognize the child’s depression.  Although the team found that teachers and parents were more skilled at identifying other symptoms that might predict long-term risk for depression, such as social problems and  inattention. This could be crucial, as Herman found that the children showing severe signs of depression were six times more likely to have skill deficits than their peers.

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Lead researcher Keith Herman, professor in the MU College of Education said: “The gold standard for identifying children who might be at risk for developing depression later in life is to ask the children themselves,” Herman said. “However, even if a child doesn’t say they feel depressed, certain outward behaviors might provide clues to the state of the child’s mental health. It’s important for teachers and parents to catch these behaviors early to prevent long-term problems that occur with depression.” (Source: Science Daily)

Full story at Science Daily Depressed children 6 times more likely to have skill deficits, MU study finds

Happiful magazine New Study Finds Parents and Teachers Struggle To Recognise Signs Of Depression In Children

Full reference: Herman, K. C. et al |2018| Using latent profile and transition analyses to understand patterns of informant ratings of child depressive symptoms|  Journal of School Psychology| P. 69, 84-99| https://doi.org/10.1016/j.jsp.2018.05.004

Abstract

The present study examined the latent profiles of child, parent, and teacher ratings of child depressive symptoms in a developmental sample of children from Hawaii at two time points (2nd and 3rd grade). The study attempted to identify patterns of agreement and discrepancy among raters and correlates of these patterns to test a new theory for understanding rating disagreements as Divergent Operations. Three profiles best described the ratings at both time points: Child-Only High Depression, Child-Only Mild Depression, and Normative (non-depressed). Second and third grade measures of child social skills, externalizing symptoms, attention problems, and language and academic competence confirmed the distinctiveness of these classes which provides support for a Divergent Operations perspective. Latent transition analyses suggested that depressive symptoms were relatively transient for each class. Implications regarding the measurement and identification of child depressive symptoms across development and the meaning and use of discrepant ratings are discussed.

Rotherham NHS staff can request this article here 

 

Parent-child therapy helps young children with depression

New research demonstrates that an interactive therapy involving parents and their depressed preschoolers can reduce rates of depression and lower the severity of children’s symptoms | The American Journal of Psychiatry | via ScienceDaily

Children as young as three can be clinically depressed, and often that depression recurs as they get older and go to school. It also can reappear during adolescence and throughout life.

New research from Washington University School of Medicine demonstrates that an interactive therapy involving parents and their depressed children can reduce rates of depression and lower the severity of children’s symptoms:

Abstract
Objective:
Clinical depression in children as young as age 3 has been validated, and prevalence rates are similar to the school-age disorder. Homotypic continuity between early and later childhood depression has been observed, with alterations in brain function and structure similar to those reported in depressed adults.

These findings highlight the importance of identifying and treating depression as early as developmentally possible, given the relative treatment resistance and small effect sizes for treatments later in life. The authors conducted a randomized controlled trial of a dyadic parent-child psychotherapy for early childhood depression that focuses on enhancing the child’s emotional competence and emotion regulation.

Method:
A modified version of the empirically tested parent-child interaction therapy with a novel “emotion development” module (PCIT-ED) was compared with a waiting list condition in a randomized controlled trial in 229 parent-child dyads with children 3–6.11 years of age. Both study arms lasted 18 weeks.

Results:
Children in the PCIT-ED group had lower rates of depression (primary outcome), lower depression severity, and lower impairment compared with those in the waiting list condition. Measures of child emotional functioning and parenting stress and depression were significantly improved in the PCIT-ED group.

Conclusions:
The findings from this randomized controlled trial of a parent-child psychotherapy for early childhood depression suggest that earlier identification and intervention in this chronic and relapsing disorder represents a key new pathway for more effective treatment. Manualized PCIT-ED, administered by master’s-level clinicians, is feasible for delivery in community health settings.

Luby, J. L. et al. |  A Randomized Controlled Trial of Parent-Child Psychotherapy Targeting Emotion Development for Early Childhood Depression | American Journal of Psychiatry | Published Online 20 June 2018

Why do People Overthink?

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Background:

The meta-cognitive model of rumination is a theoretical model regarding the relationship between rumination and depression. Although meta-cognitive therapy for rumination was established based on this model, insufficient longitudinal studies addressing this model have been conducted. Moreover, the uncontrollability of rumination, suggested to be driven by negative meta-beliefs about rumination, has not been examined using this meta-cognitive model.

Aims: We longitudinally examined the meta-cognitive model and its relationship with uncontrollability of rumination and depressive symptoms. Method: Undergraduate students (n = 117) were asked to complete two measurements (with a 6-month gap between them) of positive and negative meta-beliefs about rumination, causal analysis, understanding, uncontrollability of rumination and depression.

Results: Cross-lagged effect modelling revealed that positive meta-beliefs predicted high causal analytic rumination. However, the results did not support the causal analytic and understanding aspects of how rumination predicted negative meta-beliefs. Negative meta-beliefs predicted high depressive symptoms, and depressive symptoms predicted high negative meta-beliefs. Negative meta-beliefs predicted high uncontrollability of rumination, whereas uncontrollability of rumination did not predict depressive symptoms.

Conclusions: The results partially supported the meta-cognitive model. The prediction of depressive symptoms on negative meta-beliefs suggests that depression-related cognition might be involved in increasing negative meta-beliefs, rather than the repetitive causal analytic and understanding aspects of rumination. In line with meta-cognitive therapy, negative meta-beliefs could be a target for treating depression.

Full reference: Matsumoto, N., & Mochizuki, S. | Why do People Overthink? A Longitudinal Investigation of a Meta-Cognitive Model and Uncontrollability of Rumination |  Behavioural and Cognitive Psychotherapy | Vol 46(4), July 2018 | p504-509

Tackling bullying could help reduce depression in autistic teens

University of Bristol| June 2018 | Tackling bullying could help reduce depression in autistic teens

A new study from Bristol University has found teenagers with difficulties in social communication, including autism, have greater rates of depression, especially if they are being bullied. 

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The researchers used data from a longitudinal study and  discovered that children with autism, and young people with autistic traits, had greater symptoms of depression at age 10 than peers without autism. This trend continued until the children and young people were 18 (via Science Daily).

 

The full news story is available to read from Science Daily

An article based on this study has been published in JAMA Psychiatry

Abstract

Importance  Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear.

Objectives  To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying.

Design, Setting, and Participants  Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017.

Main Outcomes and Measures  Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule–Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years.

Results  The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results.

Conclusions and Relevance  Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.

 

The article can  be read in full at JAMA Psychiatry 

Full reference:

Rai D, Culpin I, Heuvelman H, et al.| Association of Autistic Traits With Depression From Childhood to Age 18 Years| JAMA Psychiatry | Published online June 13, 2018| doi:10.1001/jamapsychiatry.2018.1323