Kindt, K. C., Kleinjan, M., Janssens, J. M., Scholte, R. H.

The effect of a depression prevention program on negative cognitive style trajectories in early adolescents

As restructuring a negative cognitive style is a central skill taught in many depression prevention programs, we tested whether a universal prevention program evoked a change in negative cognitive style in adolescents. In addition, we examined distinct developmental trajectories of negative cognitive styles and assessed whether research condition (intervention versus control) predicted these trajectories. Young adolescents (n = 1343; Mean age = 13.4 years; SD = 0.77; 52.3% girls) were randomly allocated to a cognitive behavioral therapy (CBT)-based depression prevention program or a care as usual control condition. A negative cognitive style was assessed at baseline, post-treatment and 6- and 12-months follow-up. Adolescents who received the intervention did not differ in their negative cognitive style from the control group at any time-point.We found four distinctive trajectories of negative cognitive style: normative, increasing, decreasing and stable high, which were not predicted by intervention condition and were not moderated by gender. Yet, the results revealed a trend, which indicated that adolescents who followed the program tended to show an increasing than a normative developmental pattern. We concluded that the CBT based depression prevention program did not reduce or prevent an increase in negative cognitive style. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Health Education Research, 31(5) : 665-677

McCauley, E., Gudmundsen, G., Schloredt, K., Martell, C., Rhew, I., Hubley, S., Dimidjian, S.

The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence

This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 45(3) : 291-304

Slesnick, N., Feng, X., Guo, X., Brakenhoff, B., Carmona, J., Murnan, A., Cash, S., McRee, A. L.

A Test of Outreach and Drop-in Linkage Versus Shelter Linkage for Connecting Homeless Youth to Services

Outreach and service linkage are key for engaging marginalized populations, such as homeless youth, in services. Research to date has focused primarily on engaging individuals already receiving some services through emergency shelters, clinics, or other programs. Less is known about those who are not connected to services and, thus, likely the most vulnerable and in need of assistance. The current study sought to engage non-service-connected homeless youth (N=79) into a strengths-based outreach and advocacy intervention. Youth were randomly assigned to receive 6 months of advocacy that focused on linking youth to a drop-in center (n=40) or to a crisis shelter (n=39). All youth were assessed at baseline and 3, 6, and 9 months post-baseline. Findings indicated that youth prefer drop-in center services to the shelter. Also, the drop-in center linkage condition was associated with more service linkage overall (B=0.34, SE=0.04, p<0.01) and better alcohol-l [B=-0.39, SE=0.09, t(75)=-4.48, p<0.001] and HIV-related outcomes [B=0.62, SE=0.10, t(78)=6.34, p<0.001] compared to the shelter linkage condition. Findings highlight the importance of outreach and service linkage for reconnecting service-marginalized youth, and drop-in centers as a primary service option for homeless youth.

Prevention science : the official journal of the Society for Prevention Research, 17(4) : 450-460

Young, J. F., Benas, J. S., Schueler, C. M., Gallop, R., Gillham, J. E., Mufson, L.

A Randomized Depression Prevention Trial Comparing Interpersonal Psychotherapy--Adolescent Skills Training to Group Counseling in Schools

Given the rise in depression disorders in adolescence, it is important to develop and study depression prevention programs for this age group. The current study examined the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a group prevention program for adolescent depression, in comparison to group programs that are typically delivered in school settings. In this indicated prevention trial, 186 adolescents with elevated depression symptoms were randomized to receive IPT-AST delivered by research staff or group counseling (GC) delivered by school counselors. Hierarchical linear modeling examined differences in rates of change in depressive symptoms and overall functioning from baseline to the 6-month follow-up assessment. Cox regression compared rates of depression diagnoses. Adolescents in IPT-AST showed significantly greater improvements in self-reported depressive symptoms and evaluator-rated overall functioning than GC adolescents from baseline to the 6-month follow-up. However, there were no significant differences between the two conditions in onset of depression diagnoses. Although both intervention conditions demonstrated significant improvements in depressive symptoms and overall functioning, results indicate that IPT-AST has modest benefits over groups run by school counselors which were matched on frequency and duration of sessions. In particular, IPT-AST outperformed GC in reduction of depressive symptoms and improvements in overall functioning. These findings point to the clinical utility of this depression prevention program, at least in the short-term. Additional follow-up is needed to determine the long-term effects of IPT-AST, relative to GC, particularly in preventing depression onset.

Prevention science : the official journal of the Society for Prevention Research, 17(3) : 314- 324

Garber, J., Brunwasser, S. M., Zerr, A. A., Schwartz, K. T., Sova, K., Weersing, V.

Treatment and prevention of depression and anxiety in youth: Test of cross-over effects

Anxiety and depression are highly comorbid and share several common etiological processes. Therefore, it may be more efficient to develop interventions that treat or prevent these problems together rather than as separate entities. The present meta-analytic review examined whether interventions for children and adolescents that explicitly targeted either anxiety or depression showed treatment specificity or also impacted the other outcome (i.e. cross-over effects). We addressed this question both within the same type of study (i.e. treatment, prevention) and across study types. Only randomized controlled trials (RCTs) that assessed both constructs with dimensional measures were included in this review. For treatment studies, RCTs targeting anxiety (n = 18) showed significant effects on both anxious and depressive symptoms, although more strongly on anxiety than depression; similarly, RCTs treating depression (n = 9) yielded significant effects on both depressive and anxious symptoms, but stronger effects on depression than anxiety. Thus, there were cross-over effects in treatments purportedly targeting either anxiety or depression, and also treatment specificity, such that larger effects were seen for the target problem at which the treatment was aimed. Anxiety prevention studies (n = 14) significantly affected anxious, but not depressive symptoms, indicating no cross-over effect of anxiety prevention trials on depression. For depression prevention studies (n = 15), the effects were not significant for either depressive or anxiety symptoms, although the effect was significantly larger for depressive than for anxious symptoms. Post-hoc analyses revealed that the effect on depressive symptoms was significant in depression preventions trials of targeted but not universal samples. Implications for transdiagnostic interventions are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Depression and Anxiety, 33(10) : 939-959

Xu, Y., Bai, S. J., Lan, X. H., Qin, B., Huang, T., Xie, P.

Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability

New generation antidepressant therapies, including serotonin- norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide- related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.

Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas, 49(6) :

Yan, S., Jin, Y., Oh, Y., Choi, Y.

Effect of exercise on depression in university students: a meta-analysis of randomized controlled trials

INTRODUCTION: The aim of this study was to assess the effect of exercise on depression in university students. EVIDENCE ACQUISITION: A systematic literature search was conducted in PubMed, EMBASE and the Cochrane library from their inception through December 10, 2014 to identify relevant articles. The heterogeneity across studies was examined by Cochran's Q statistic and the I2 statistic. Standardized mean difference (SMD) and 95% confidence interval (CI) were pooled to evaluate the effect of exercise on depression. Then, sensitivity and subgroup analyses were performed. In addition, publication bias was assessed by drawing a funnel plot. EVIDENCE SYNTHESIS: A total of 352 participants (154 cases and 182 controls) from eight included trials were included. Our pooled result showed a significant alleviative depression after exercise (SMD=-0.50, 95% CI: -0.97 to -0.03, P=0.04) with significant heterogeneity (P=0.003, I2=67%). Sensitivity analyses showed that the pooled result may be unstable. Subgroup analysis indicated that sample size may be a source of heterogeneity. Moreover, no publication bias was observed in this study. CONCLUSIONS: Exercise may be an effective therapy for treating depression in university students. However, further clinical studies with strict design and large samples focused on this specific population should be warranted in the future.

The Journal of sports medicine and physical fitness, 56(6) : 811-816

Bella-Awusah, T., Ani, C., Ajuwon, A., Omigbodun, O.

Effectiveness of brief school-based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria

Background: There is paucity of evidence-based psychological interventions for depressive disorders in Africa, more so among depressed children and adolescents. This study aimed to determine the effects of a school-based cognitive behavioural therapy programme (CBT) on depressed adolescents in South West Nigeria. Methods: Forty students who scored 18 or above on the Beck Depression Inventory (BDI) were recruited from two schools (20 from each school). One school was designated intervention and the other a wait-list control school. Five weekly sessions of group CBT programme were conducted in the intervention school. Primary outcome measure was the Beck Depression Inventory, and secondary outcome measures were the Short Mood and Feelings Questionnaire and the Impact Supplement of the Strengths and Difficulties Questionnaire. Results: Controlling for baseline scores and other confounders, the intervention group had significantly lower depressive symptoms scores on the BDI and SMFQ 1 week post intervention with large effect sizes. The intervention group maintained the treatment effect with significantly lower depression scores 16 weeks post intervention compared with their baseline scores. The effect sizes remained large. The intervention and control groups did not differ in their SDQ impact supplement scores post intervention, but the intervention group improved significantly on this measure at 16 weeks. Conclusions: To our knowledge, this is the first study of a school-based group CBT programme for depressed adolescents in Africa. The programme showed good feasibility and promising effectiveness.

Child & Adolescent Mental Health, 21(1) : 44-50

Androne, F. T., Candea, C., Alboaie, A. F., Patrascu, M.

Evaluation of cognitive functioning during antidepressant treatment in young patients with severe major depressive disorder [abstract]

Background: Psychosocial functioning and cognitive disorders seem to be interconnected in major depressive disorder (MDD); it is important to investigate this phenomenon in a young and active population. Reduced performance in domains like attention and processing speed, executive function, or verbal knowledge correlate with relational and professional efficiency [1]. Impairments of neuroplasticity in hippocampus, amygdala and cortex are considered to instrumental in the appearance of disfunctions in learning, memory and emotional processing in depressive disorders, with decreased adult neurogenesis in the hippocampus, as well as reduced neuronal size and glial cell density in the prefrontal cortex as pathogenic substrates [2,3]. The effects of antidepressants on the brain are suspected to be mediated, at least partially, by astrocytes acting directly on neuronal networks [4]. Objective: To compare the medium-term efficacy of several classes of antidepressants with respect to cognitive functioning in major depressive disorder in a young patient population. Methods: A group of 44 patients, 28 females and 16 males, mean age 22.6 years, diagnosed with MDD (according to DSM 5 criteria), who presented significant depressive symptoms at admission, were randomized to receive flexible daily doses of escitalopram 10-20 mg (n = 8), fluoxetine 20-40 mg (n = 8), tianeptine 25-37.5 mg (n = 8), mirtazapine 30-45 mg (n = 6), bupropion 150- 300 mg (n = 6), venlafaxine 150-225 mg (n = 4) or duloxetine 60-90 mg (n = 4). Patients were monitored every 4 weeks during 6 months using neuropsychological assessment scales for seven cognitive domains (problem solving and planning, decision making, verbal fluency, processing speed, immediate verbal memory, immediate visual memory, long-term verbal memory), Hamilton Depression Rating Scale (HAMD) - 17 items and Clinical Global Impression - Severity (CGI-S). Inclusion criteria: HAMD >23 at admission, CGI-S =5, no antidepressant treatment in the 6 weeks before baseline assessment, age between 18 and 30. Exclusion criteria: psychiatric or somatic severe comorbid disorders, active suicidal ideation in the last 12 months, prior suicidal behaviors. Intentto- treat-analysis and last-observation-carried-forward were used in the statistical processing of data. Results: Depressive symptoms responded well to antidepressants, as the overall HAMD score at endpoint improved compared to baseline with 35±2.2%. 36.3% of subjects were responders (defined as HAMD <7), while 40.9% were partial responders (HAMD =7 but <16), 11.3% non-responders (HAMD =16) and 11.3% early discontinuations due to lack of efficacy. CGI-S decreased by a mean of 27.1% compared to baseline. The differences between antidepressants did not reach the level of significance (set at 0.05) at endpoint regarding either HAMD or CGI-S scores. Repeated cognitive evaluations suggested an overall significant improvement (p <0.05) in problem solving and planning (14.2±1.2%), verbal fluency (10.2±0.9%), long-term verbal memory (6.2±2.1%) and processing speed (5.6±1.1%). When each treatment group was analyzed individually, a trend for superior efficacy was observed for mirtazapine (p = 0.044) and bupropion (p = 0.049), but these differences disappeared when the number of previous mood episodes and baseline severity were accounted for. Conclusion: Antidepressant treatment ameliorates cognitive functioning in major depressive episodes in young patients; this improvement could be very important in an active population, increasing the chances for a rapid psychosocial and professional rehabilitation.

European Neuropsychopharmacology, 26 : S60-S61

Arnedt, J. T., Swanson, L. M., Dopp, R. R., Bertram, H. S., Mooney, A. J., Huntley, E. D., Hoffmann, R. F., Armitage, R.

Effects of restricted time in bed on antidepressant treatment response: A randomized controlled trial

Objective: Antidepressant response onset is delayed in individuals with major depressive disorder (MDD). This study compared remission rates and time to remission onset for antidepressant medication delivered adjunctively to nightly time in bed (TIB) restriction of 6 hours or 8 hours for the initial 2 weeks. Methods: Sixty-eight adults with DSM-IV?diagnosed MDD (mean +/- SD age = 25.4 +/- 6.6 years, 34 women) were recruited from September 2009 to December 2012 in an academic medical center. Participants received 8 weeks of open-label fluoxetine 20?40 mg and were randomized to 1 of 3 TIB conditions for the first 2 weeks: 8-hour TIB (n = 19); 6-hour TIB with a 2-hour bedtime delay (late bedtime, n = 24); or 6-hour TIB with a 2-hour rise time advance (early rise time, n = 25). Clinicians blinded to TIB condition rated symptom severity weekly. Symptom severity, remission rates, and remission onset as rated by the 17-item Hamilton Depression Rating Scale were the primary outcomes. Results: Mixed effects models indicated lower depression severity for the 8-hour TIB compared to the 6-hour TIB group overall (F8, 226.9 = 2.1, P < .05), with 63.2% of 8-hour TIB compared to 32.6% of 6-hour TIB subjects remitting by week 8 (X² 1 = 4.9, P < .05). Remission onset occurred earlier for the 8-hour TIB group (hazard ratio = 0.43; 95% CI, 0.20?0.91; P < .03), with no differences between 6-hour TIB conditions. Conclusions: Two consecutive weeks of nightly 6-hour TIB does not accelerate or improve antidepressant response. Further research is needed to determine whether adequate sleep opportunity is important to antidepressant treatment response. Trial Registration: ClinicalTrials.gov identifier: NCT01545843. © Copyright 2016 Physicians Postgraduate Press, Inc.

Journal of Clinical Psychiatry, 77(10) : e1218- e1225

Balchin, R., Linde, J., Blackhurst, D., Rauch, H. L., Schonbachler, G.

Sweating away depression? the impact of intensive exercise on depression

Background: In periods of prolonged stress and pain the body produces endorphins to help endure pain. The PANIC system is built on the same pathways as the pain system and is characterized by behaviour that looks like depression. The term 'mental pain' in the context of feelings of loss is arguably justified in light of this relationship between the physical pain and social loss systems. It is reasonable to expect that endorphin release ameliorates depression. Methods: Moderately depressed males (n=30) were randomly assigned to one of three groups of varying exercise intensity. Each underwent a six-week exercise programme for three days per week, one hour per day. The HAM-D, MADRS, and ANPS were administered weekly and ß-endorphin levels measured. Results Moderate- and high-intensity exercise improved depression levels, while very-low intensity exercise did not have as beneficial an effect. ß-endorphin results were inconclusive. Participants showed a slight decrease in PANIC and FEAR, and increased SEEKING. Limitations: The potential insensitivity of the assays that were utilized, and the known problems with measuring ß-endorphins, may have contributed to the findings. The lack of a state measure of the basic emotion systems is problematic, as a trait measure has to be relied upon, and this likely affected the ability to accurately detect changes over time. Conclusions: The demonstrated improvements in depressive symptoms have important implications for the clinical treatment of patients despite the hypothesis that the PANIC system is involved in the genesis and maintenance of depression not having been conclusively confirmed.

Journal of Affective Disorders, 200 : 218-221

Bluth, K., Campo, R. A., Pruteanu- Malinici, S., Reams, A., Mullarkey, M., & Broderick, P. C

A school-based mindfulness pilot study for ethnically diverse at-risk adolescents

Mindfulness, 7(1) : 90- 104