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

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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

 

Child’s IQ may be linked to mother’s depression

Science Daily | April 2018 | Mother’s depression might do the same to her child’s IQ


The children of mothers who experience depression may not provide toys and books to support their learning or be as emotionally available to their child,  compared to mothers who did not report depression. Researchers 
studied mothers and 700 children in Chile assessing them  every five years, until the children were 16. They observed the mothers with their children, noted their interactions and any learning materials they provided for them. Alongside this the mothers also completed questionnaires which asked them about their emotions and mental health.  The researchers found that the children of mothers with severe  depression had a lower average verbal IQ score (7.30) compared to a score of 7.78 in children without depressed mothers.  They surmise that the children’s IQ measured at 1, 6, 11 and 16 was affected by this. (via Science Dailychild-2916844_1920

Abstract
This study examined the associations among maternal depression, mothers’ emotional and material investment in their child, and children’s cognitive functioning. Middle‐class Chilean mothers and children (N equal to 875; 52% males) were studied when children were 1, 5, 10, and 16 years (1991–2007). Results indicated that highly depressed mothers provided less emotional and material support to their child across all ages, which related to children’s lower IQ. Children with lower mental abilities at age 1 received less learning‐material support at age 5, which led to mothers’ higher depression at child age 10. Mothers’ low support was more strongly linked to maternal depression as children got older. Findings elucidate the dynamic and enduring effects of depression on mothers’ parenting and children’s development.

The article is published in Child Development. Rotherham NHS staff can request the article here

National Patterns of Commonly Prescribed Psychotropic Medications to Young People

A new US study has found that medications prescribed to treat young people with psychiatric disorders such as depression may be under prescribed. The researchers compared prescribing rates with prevalence rates for the most common psychiatric disorders in children (Science Daily).

group of children and young people

The full text article is available here from The Journal of Child and Adolescent Psychopharmacology

The full feature from Science Daily

Full reference:  Sultan, R. S., et al. |National Patterns of Commonly Prescribed Psychotropic Medications to Young People| Journal of Child and Adolescent Psychopharmacology|2018|DOI: 10.1089/cap.2017.0077

 

‘Depression education’ effective for some teens

In an assessment of their ‘depression literacy’ program, which has already been taught to tens of thousands, researchers say the Adolescent Depression Awareness Program achieved its intended effect of encouraging many teenagers to speak up and seek adult help for themselves or a peer. | ScienceDaily | American Journal of Public Health

Objectives. To determine the effectiveness of a universal school-based depression education program.

Methods. In 2012–2015, we matched 6679 students from 66 secondary schools into pairs by state (Maryland, Delaware, Pennsylvania, Michigan, and Oklahoma) and randomized to the Adolescent Depression Awareness Program (ADAP; n = 3681) or to a waitlist control condition (n = 2998). Trained teachers delivered ADAP as part of the health education curriculum to students aged 14 to 15 years. The primary outcome was depression literacy. Secondary outcomes included mental health stigma and, in a subset of the sample, the receipt of mental health services. Follow-up was at 4 months.

Results. ADAP resulted in significantly higher levels of depression literacy among participating students than did waitlist controls, after adjusting for pretest assessment depression literacy (P < .001). Overall, ADAP did not significantly affect stigma (P = .1). After ADAP, students approached 46% of teachers with concerns about themselves or others. Of students who reported the need for depression treatment, 44% received treatment within 4 months of ADAP implementation.

Conclusions. ADAP is an effective public health intervention for improving depression literacy among students.

Read more at ScienceDaily

Full reference: Swartz, K. et al. | School-Based Curriculum to Improve Depression Literacy Among US Secondary School Students: A Randomized Effectiveness Trial | American Journal of Public Health |  2017; 107 (12): 1970

Body dissatisfaction causing long lasting consequences for young people

Body dissatisfaction can start as young as six and lead to depression, anxiety and eating issues | Youth Select Committee

body image

The Youth Select Committee, a British Youth Council initiative, is supported by the House of Commons and has 11 members aged from 13 to 18. This week, the committee is launching its report, A Body Confident Future which looks at the issue of body image, an issue highlighted as an area of concern in a recent poll of thousands of young people.

The Committee’s key recommendations include:

  • Government sponsorship of an annual ‘National Body Confidence Week’ which would be supported by all relevant departments.
  • Introduction of minimum standards for social media companies in relation to content moderation, to be enforced in the forthcoming digital charter.
  • Measures to improve the diversity of advertising campaigns.
  • Adequate funding for schools so that pupils are supported in their wider wellbeing, including on issues related to body dissatisfaction.
  • Greater focus on body image in online resources aimed at young people, teachers and parents.

Full detail at British Youth Council

See also: BBC News: Young people out of love with their own bodies, says report