Disorders - Depressive Disorders
McLaughlin, K. A., Zeanah, C. H., Fox, N. A., Nelson, C. A.
Children reared in institutions experience elevated rates of psychiatric disorders. Inability to form a secure attachment relationship to a primary caregiver is posited to be a central mechanism in this association. We determined whether the ameliorative effect of a foster care (FC) intervention on internalizing disorders in previously institutionalized children was explained by the development of secure attachment among children placed in FC. Second we evaluated the role of lack of attachment in an institutionalized sample on the etiology of internalizing disorders within the context of a randomized trial. A sample of 136 children (aged 6-30 months) residing in institutions was recruited in Bucharest, Romania. Children were randomized to FC (n = 68) or to care as usual (CAU; n = 68). Foster parents were recruited, trained, and overseen by the investigative team. Attachment security at 42 months was assessed using the Strange Situation Procedure, and internalizing disorders at 54 months were assessed using the Preschool Age Psychiatric Assessment. Girls in FC had fewer internalizing disorders than girls in CAU (OR = 0.17, p = .006). The intervention had no effect on internalizing disorders in boys (OR = 0.47, p = .150). At 42 months, girls in FC were more likely to have secure attachment than girls in CAU (OR = 12.5, p < .001), but no difference was observed in boys (OR = 2.0, p = .205). Greater attachment security predicted lower rates of internalizing disorders in both sexes. Development of attachment security fully mediated intervention effects on internalizing disorders in girls. Placement into FC facilitated the development of secure attachment and prevented the onset of internalizing disorders in institutionalized girls. The differential effects of FC on attachment security in boys and girls explained gender differences in the intervention effects on psychopathology. Findings provide evidence for the critical role of disrupted attachment in the etiology of internalizing disorders in children exposed to institutionalization. (copyright) 2011 The Authors. Journal of Child Psychology and Psychiatry (copyright) 2011 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 53(1) : 46-55
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Kidger, J., Araya, R., Donovan, J., Gunnell, D.
BACKGROUND AND OBJECTIVES: The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the school environment in cohort studies. METHODS: Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers. RESULTS: Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological shortcomings were common. CONCLUSIONS: There is limited evidence that the school environment has a major influence on adolescent mental health, although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring schoollevel factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs. Copyright (copyright) 2012 by the American Academy of Pediatrics.
Pediatrics, 129(5) : 925-949
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Kutcher, S., Wei, Y.
PURPOSE OF REVIEW: Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment. RECENT FINDINGS: In contrast to the abundance of school-based mental health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration. SUMMARY: Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental health promotion, prevention and intervention. (copyright) 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Current Opinion in Psychiatry, 25(4) : 311-316
- Year: 2012
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Merry, S. N., Stasiak, K., Shepherd, M., Frampton, C., Fleming, T., Lucassen, M. F.
To evaluate whether a new computerised cognitive behavioural therapy intervention (SPARX, Smart, Positive, Active, Realistic, X-factor thoughts) could reduce depressive symptoms in help seeking adolescents as much or more than treatment as usual. Multicentre randomised controlled non-inferiority trial. 24 primary healthcare sites in New Zealand (youth clinics, general practices, and school based counselling services). 187 adolescents aged 12-19, seeking help for depressive symptoms, with no major risk of self harm and deemed in need of treatment by their primary healthcare clinicians: 94 were allocated to SPARX and 93 to treatment as usual. Computerised cognitive behavioural therapy (SPARX) comprising seven modules delivered over a period of between four and seven weeks, versus treatment as usual comprising primarily face to face counselling delivered by trained counsellors and clinical psychologists. The primary outcome was the change in score on the children's depression rating scale-revised. Secondary outcomes included response and remission on the children's depression rating scale-revised, change scores on the Reynolds adolescent depression scale-second edition, the mood and feelings questionnaire, the Kazdin hopelessness scale for children, the Spence children's anxiety scale, the paediatric quality of life enjoyment and satisfaction questionnaire, and overall satisfaction with treatment ratings. 94 participants were allocated to SPARX (mean age 15.6 years, 62.8% female) and 93 to treatment as usual (mean age 15.6 years, 68.8% female). 170 adolescents (91%, SPARX n = 85, treatment as usual n = 85) were assessed after intervention and 168 (90%, SPARX n = 83, treatment as usual n = 85) were assessed at the three month follow-up point. Per protocol analyses (n = 143) showed that SPARX was not inferior to treatment as usual. Post-intervention, there was a mean reduction of 10.32 in SPARX and 7.59 in treatment as usual in raw scores on the children's depression rating scale-revised (between group difference 2.73, 95% confidence interval -0.31 to 5.77; P=0.079). Remission rates were significantly higher in the SPARX arm (n = 31, 43.7%) than in the treatment as usual arm (n = 19, 26.4%) (difference 17.3%, 95% confidence interval 1.6% to 31.8%; P = 0.030) and response rates did not differ significantly between the SPARX arm (66.2%, n = 47) and treatment as usual arm (58.3%, n = 42) (difference 7.9%, -7.9% to 24%; P = 0.332). All secondary measures supported non-inferiority. Intention to treat analyses confirmed these findings. Improvements were maintained at follow-up. The frequency of adverse events classified as "possibly" or "probably" related to the intervention did not differ between groups (SPARX n = 11; treatment as usual n = 11). SPARX is a potential alternative to usual care for adolescents presenting with depressive symptoms in primary care settings and could be used to address some of the unmet demand for treatment. Australian New Zealand Clinical Trials ACTRN12609000249257.
British Journal of Psychiatry, 344 : e2598
- Year: 2012
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
McMillan, L., Owen, L., Kras, M., Scholey, A.
There are surprisingly few randomised, controlled trials into the effects of dietary change on mood and cognition in healthy individuals. Here we examined the effects of 10 days of changing to a nutrient-rich diet on mood and cognitive performance. Young female adults (N = 25) were randomised to a diet change (DC), or a no change (NC) control group. Those in the DC condition adhered to the nutrient-dense Mediterranean diet. Mood and cognitive performance were assessed at baseline and on day 10. Compared with the NC group, the DC group showed significant improvements in self-rated vigour, alertness and contentment. Changes in cognitive tasks were somewhat inconsistent. These preliminary findings require verification in larger trials but suggest that appropriate dietary change may benefit mood and some aspects of cognitive performance in healthy adults. All rights reserved, Elsevier.
Appetite, 56(1) : 143-147
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Dietary advice, dietary change
McNamara, R. K., Adler, C., Strawn, J., Strimpfel, J., Weber, W., Chu, W. J., Jandacek, R., Rider, T., Tso, P., Strakowski, S. M., DelBello, M. P.
Background: Adults with major depressive disorder (MDD) exhibit deficits in erythrocyte long-chain omega-3 (n-3) fatty acid composition. However, there is currently little known about the n-3 fatty acid status of adolescents with MDD, or the relationships between long-chain n-3 fatty acid supplementation and changes in symptom severity and brain neurochemistry. Methods: Erythrocyte fatty acid composition was determined in adolescents (10-20 years) meeting DSM-IV criteria for MDD (n=20) and healthy adolescents (n=20). Patients were randomized to one of two doses of fish oil (2.4 or 15 g/d) for 10 weeks. At baseline and endpoint, depression symptom severity (CDRS-R) and cortical 1H MRS metabolite (ml, Cho, Cr, NAA, Glx) concentrations were determined. Results: Compared with healthy adolescents, docosahexaenoic acid (DHA, 22:6n-3), the principal n-3 fatty acid in erythrocyte and cortical membranes, was significantly lower in adolescents with MDD (-26%, p = 0.004). The n-3 fatty acid eicosapentaneoic acid (20:5n-3) and n-6 fatty acid arachidonic acid (AA, 20:4n-6) did not differ between groups. Fish oil supplementation significantly increased erythrocyte DHA composition in low-dose (+49%, p<0.0001) and high-dose (+52%, p = 0.0001) groups at 10 weeks. Baseline CDRS total scores declined significantly in low-dose (-18%, p=0.01) and high-dose (-38%, p<0.0001) groups at 10 weeks. There were no significant baselineendpoint changes in metabolite concentrations in right or left dorsolateral prefrontal cortex or anterior cingulate. Conclusions: Adolescent MDD is associated with erythrocyte DHA deficits, and dietary-induced elevations in erythrocyte DHA levels are associated with reductions in depression symptom severity independent of changes in cortical 1H MRS metabolite concentrations.
Biological Psychiatry, 69(9) : 276S
- Year: 2011
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Maalouf, F. T., Atwi, M., Brent, D. A.
Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re-assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed. Depression and Anxiety, 2011. (copyright) 2011 Wiley Periodicals, Inc. (copyright) 2011 Wiley Periodicals, Inc.
Depression & Anxiety, 28(11) : 946-954
- Year: 2011
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Midgley, N., Kennedy, E.
For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of 'empirically supported treatments'. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration. (copyright) 2011 Copyright Taylor and Francis Group, LLC.
Journal of Child Psychotherapy, 37(3) : 232-260
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Merry, S. N., Hetrick, S. E., Cox, G. R., Bir, J. J., McDowell, H.
Background Depression is common in young people, has amarked negative impact and is associated with self-harmand suicide. Preventing its onset would be an important advance in public health.
Objectives To determine whether psychological or educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.
Search methods The Cochrane Depression, Anxiety and Neurosis Review Group's trials registers (CCDANCTR) were searched at the editorial base in July 2010. Update searches of MEDLINE, EMBASE, PsycINFO and ERIC were conducted by the authors in September 2009.
Conference abstracts, reference lists of included studies and reviews were searched and experts in the field contacted.
Selection criteria Randomised controlled trials of psychological or educational prevention programmes, or both, compared with placebo, any comparison intervention, or no intervention for young people aged 5 to 19 years-old, who did not currently meet diagnostic criteria for depression or who were below the clinical range on standardised, validated, and reliable rating scales of depression, or both, were included.
Data collection and analysis Two authors independently assessed studies for inclusion and rated their quality. Sample sizes were adjusted to take account of cluster designs and multiple comparisons. We contacted study authors for additional information where needed.
Main results Fifty-three studies including 14,406 participants were included in the analysis. There were only six studies with clear allocation concealment, participants and assessors were mostly not blind to the intervention or blinding was unclear so that the overall risk of bias was moderately high. Sixteen studies including 3240 participants reported outcomes on depressive diagnosis. The risk of having a depressive disorder post-intervention was reduced immediately compared with no intervention (15 studies; 3115 participants risk difference (RD) -0.09; 95% confidence interval (CI) -0.14 to -0.05; P<0.0003), at three to nine months (14 studies; 1842 participants; RD -0.11; 95% CI -0.16 to -0.06) and at 12 months (10 studies; 1750 participants; RD -0.06; 95% CI -0.11 to -0.01). There was no evidence for continued efficacy at 24 months (eight studies; 2084 participant; RD -0.01; 95% CI -0.04 to 0.03) but limited evidence of efficacy at 36 months (two studies; 464 participants; RD -0.10; 95% CI -0.19 to -0.02). There was significant heterogeneity in all these findings. There was no evidence of efficacy in the few studies that compared intervention with placebo or attention controls.
Authors' conclusions There is some evidence fromthis review that targeted and universal depression prevention programmesmay prevent the onset of depressive disorders compared with no intervention. However, allocation concealment is unclear in most studies, and there is heterogeneity in the findings. The persistence of findings suggests that this is real and not a placebo effect.
Cochrane Database of Systematic Reviews, CD003380(12) :
- Year: 2011
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Legrand, F. D., Thatcher, J.
In the present controlled experiment, we examine the influence of opposite states of mind (the "telic" vs. "paratelic" state) on mood response to a 15min long walk at self-selected pace. Fifty-five first-year students were randomized to a telic (n = 22) or paratelic (n = 33) motivational environment. These opposed motivational environments were created using established reversal theory based procedures to induce the telic versus paratelic state. More than 90% of participants walked within a motivational state corresponding to the environment they were allocated. No significant mood changes (neither positive, nor negative) occurred pre- to postexercise in participants who walked with the telic state operative (p > .05). This has important implications when considering the use of exercise to relieve depression in clinical populations. Also, our findings shed new light on the reasons why not all individuals respond in the same way to moderate exercise. Practically, these results suggest that motivational state should be considered to optimize the mood enhancing effects of aerobic exercise. (copyright) 2011 American Psychological Association.
Emotion, 11(5) : 1040-1045
- Year: 2011
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Lemmens, S. G., Born, J. M., Martens, E. A., Martens, M. J., Westerterp-Plantenga, M. S.
Consumption of meals with different macronutrient contents, especially high in carbohydrates, may influence the stress-induced physiological and psychological response. The objective of this study was to investigate effects of consumption of a high-protein vs. high-carbohydrate meal on the physiological cortisol response and psychological mood response. Subjects (n = 38, 19 m/19f, age =25 (plus or minus) 9 yrs, BMI = 25.0 (plus or minus) 3.3 kg/m2) came to the university four times, fasted, for either condition: rest-protein, stress-protein, rest-carbohydrate, stress-carbohydrate (randomized cross-over design). Stress was induced by means of a psychological computer-test. The test-meal was either a high-protein meal (En% P/C/F 65/5/30) or a high-carbohydrate meal (En% P/C/F 6/64/30), both meals were matched for energy density (4 kJ/g) and daily energy requirements (30%). Per test-session salivary cortisol levels, appetite profile, mood state and level of anxiety were measured. High hunger, low satiety (81 (plus or minus) 16, 12 (plus or minus) 15 mm VAS) confirmed the fasted state. The stress condition was confirmed by increased feelings of depression, tension, anger, anxiety (AUC stress vs. rest p < 0.02). Consumption of the high-protein vs. high-carbohydrate meal did not affect feelings of depression, tension, anger, anxiety. Cortisol levels did not differ between the four test-sessions in men and women (AUC nmol(middle dot)min/L p > 0.1). Consumption of the test-meals increased cortisol levels in men in all conditions (p < 0.01), and in women in the rest-protein and stress-protein condition (p < 0.03). Men showed higher cortisol levels than women (AUC nmol(middle dot)min/L p < 0.0001). Consumption of meals with different macronutrient contents, i.e. high-protein vs. high-carbohydrate, does not influence the physiological and psychological response differentially. Men show a higher meal-induced salivary cortisol response compared with women.
PLoS ONE, 6(2) : e16826
- Year: 2011
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Dietary advice, dietary change
Kim, G. H., Kim, K., Park, H.
Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide. The purpose of this study therefore was to develop and examine the effectiveness of an int ived a depression-reducing program in eight 1-hr weekly sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college students. (copyright) The Author(s) 2011.
Western Journal of Nursing Research, 33(4) : 560-576
- Year: 2011
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions