The interactive association of proximal life stress and cumulative HPA axis functioning with depressive symptoms.

BACKGROUND: Stress is consistently implicated in depression. Using a vulnerability-stress framework, the hypothalamic-pituitary-adrenal (HPA) axis may be one factor affecting the stress-depression association. However, the interactive influence of recent life stress and HPA axis functioning on depressive symptoms remains unclear. It is particularly important to understand the synergistic association during adolescence, as this is a developmental period associated with a high risk for depression. METHODS: A community sample of 58 adolescents (67% female, 59% Caucasian; mean age, 15.07 years) participated. Adolescents completed a well-validated measure of depressive symptoms and a structured life events interview to assess recent life stress. Hair cortisol concentration was obtained to measure cumulative exposure to HPA axis functioning. RESULTS: Recent life stress and cumulative HPA axis exposure measured through hair cortisol were directly associated with higher depressive symptoms. Further, cumulative HPA axis exposure moderated the relationship between recent life stress and depressive symptoms. The recent life stress-depression association occurred for adolescents who experienced average and high, but not low, levels of cumulative HPA axis exposure. CONCLUSIONS: The current study builds on prior work and finds both a direct and interactive association of recent life stress and cumulative HPA axis functioning with depressive symptoms during adolescence. Identifying youth who experience high levels of HPA axis exposure is important to prevent the onset of depression.

Cognitive reappraisal attenuates the association between depressive symptoms and emotional response to stress during adolescence.

Depression is associated with increased emotional response to stress. This is especially the case during the developmental period of adolescence. Cognitive reappraisal is an effective emotion regulation strategy that has been shown to reduce the impact of emotional response on psychopathology. However, less is known about whether cognitive reappraisal impacts the relationship between depressive symptoms and emotional responses, and whether its effects are specific to emotional reactivity or emotional recovery. The current study examined whether cognitive reappraisal moderated the relationship between depressive symptoms and trait or state measures of emotional reactivity and recovery. A community sample of 127 adolescents (M-age = 15.28; 49% female, 47% Caucasian), at an age of risk for depression, completed self-report measures of trait emotional responding and depressive symptoms. In addition, they completed an in vivo social stress task and were assessed on state emotional reactivity and recovery from the stressor. Findings suggested that cognitive reappraisal was associated with an attenuated impact of depressive symptoms on trait and state emotional recovery. These results provide evidence that cognitive reappraisal may be an effective strategy for improving some aspects of emotional responding in relation to depressive symptoms among adolescents.

Sex Differences in the Association between Heavy Drinking and Behavioral Distress Tolerance and Emotional Reactivity Among Non-Depressed College Students.

BACKGROUND: Heavy episodic drinking (HED) is a common behavior among college students that is associated with severe negative consequences. Negative reinforcement processes have been applied to elucidate mechanisms underlying relationships between consumption of alcohol and the desire to alleviate negative feelings. Distress tolerance (DT) and emotional reactivity are two mechanisms that are consistent with the self-medication model that may contribute to HED. The current study investigated relationships between DT, emotional reactivity, defined as frustration reactivity and irritability reactivity, and HED in a non-depressed college population. Given differential patterns of consumption and motivation for drinking between males and females, sex differences were also examined. SHORT SUMMARY: The study examined two constructs consistent with negative reinforcement processes, behavioral distress tolerance (DT) and emotional reactivity (frustration reactivity and irritability reactivity), to explain heavy episodic drinking (HED) among non-depressed college students. Behavioral DT and frustration reactivity independently predicted HED. Higher HED was associated with higher frustration reactivity and lower behavioral DT in women, but nor in men. METHODS: One-hundred-ten college students without depressive symptoms completed alcohol use measures and the Paced Auditory Serial Attention Task (PASAT-C) to assess behavioral DT and emotional reactivity. RESULTS: DT and frustration reactivity independently predicted HED. The association between DT and HED was moderated by sex such that higher levels of DT predicted higher HED among females, but not among males. Higher frustration reactivity scores were associated with a greater number of HED. CONCLUSIONS: Results provide supporting evidence that DT and emotional reactivity are distinct factors, and that they predict HED independently. Results underscore the importance of examining sex differences when evaluating the association between HED and negative reinforcement processes in this population.

Mindfulness-based cognitive therapy for depressed individuals improves suppression of irrelevant mental-sets.

An impaired ability to suppress currently irrelevant mental-sets is a key cognitive deficit in depression. Mindfulness-based cognitive therapy (MBCT) was specifically designed to help depressed individuals avoid getting caught in such irrelevant mental-sets. In the current study, a group assigned to MBCT plus treatment-as-usual (n = 22) exhibited significantly lower depression scores and greater improvements in irrelevant mental-set suppression compared to a wait-list plus treatment-as-usual (n = 18) group. Improvements in mental-set-suppression were associated with improvements in depression scores. Results provide the first evidence that MBCT can improve suppression of irrelevant mental-sets and that such improvements are associated with depressive alleviation.

Interaction of Biological Stress Recovery and Cognitive Vulnerability for Depression in Adolescence.

Major Depressive Disorder is a common mental illness with rates increasing during adolescence. This has led researchers to examine developmental antecedents of depression. This study examined the association between depressive symptoms and the interaction between two empirically supported risk factors for depression: poor recovery of the biological stress system as measured through heart rate and cortisol, and cognitive vulnerabilities as indexed by rumination and a negative cognitive style. Adolescents (n = 127; 49 % female) completed questionnaires and a social stress task to elicit a stress response measured with neuroendocrine (cortisol) and autonomic nervous system (heart rate) endpoints. The findings indicated that higher depressive symptoms were associated with the combination of higher cognitive vulnerabilities and lower cortisol and heart rate recovery. These findings can enhance our understanding of stress responses, lead to personalized treatment, and provide a nuanced understanding of depression in adolescence.

Cognitive Attributions in Depression: Bridging the Gap between Research and Clinical Practice.

Individuals seeking treatment for depression often are struggling with maladaptive cognitions that impact how they view themselves and the world. Research on cognitive attributions that underlie depressed mood focuses on the phenomenon of negative cognitive style, in which depressed people tend to view undesirable occurrences in life as having internal, stable, and global causes. Based on research, clinicians have developed various techniques that seek to modify depressive attributions in order to alleviate symptoms of depression. In this article, the authors review the literature on attributions in depression, present clinically relevant interventions based on empirical support, provide case examples, and summarize future directions and recommendations for researchers and practitioners.

Similar changes in cognitions following cognitive-behavioral therapy or escitalopram for major depressive disorder: Implications for mechanisms of change.

BACKGROUND: Psychosocial treatments and medications both have been shown to be effective in treating major depressive disorder. We hypothesized that cognitive-behavioral therapy (CBT) would outperform medication on measures of cognitive change. METHODS: We randomized depressed individuals to 12 weeks of CBT (n = 15) or escitalopram (n = 11). In an intent-to-treat analysis (n = 26), we conducted a repeated measures analysis of variance to examine changes in depressive symptoms (ie, 17-item Hamilton Depression Rating Scale, Beck Depression Inventory), anhedonia (ie, Snaith-Hamilton Pleasure Scale), cognitive measures (ie, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire, Perceived Stress Scale), and quality of life (ie, Quality of Life Enjoyment and Satisfaction Questionnaire) at 4 time points: baseline, week 4, week 8, and week 12. Treatment for both groups started at baseline, and patients received either 12 weeks of individual CBT or 12 weeks of escitalopram with flexible dosing (10 to 20 mg). RESULTS: Collapsing the escitalopram and CBT groups, there were statistically significant pre-post changes on all outcome measures. However, there were no statistically significant differences between treatment groups on any of the outcome measures, including cognitive measures across time points. CONCLUSIONS: Our results suggest that both CBT and escitalopram have similar effects across a variety of domains and that, in contrast to our a priori hypothesis, CBT and escitalopram were associated with comparable changes on cognitive measures.

Pubertal Timing, Peer Victimization, and Body Esteem Differentially Predict Depressive Symptoms in African American and Caucasian Girls.

This study prospectively examined pubertal timing and peer victimization as interactive predictors of depressive symptoms in a racially diverse community sample of adolescents. We also expanded on past research by assessing body esteem as a mechanism by which pubertal timing and peer victimization confer risk for depression. In all, 218 adolescents (53.4% female, 49.3% African American, 50.7% Caucasian) completed both a baseline assessment and a follow-up assessment approximately 8 months later. Early maturing Caucasian girls and late maturing African American girls experienced the greatest increases in depressive symptoms at follow-up if they experienced higher levels of peer victimization between baseline and follow-up. Furthermore, body esteem significantly mediated the relationship between pubertal timing, peer victimization, and depressive symptoms for girls of both races. The interaction of pubertal timing and peer victimization did not predict depressive symptoms for boys of either race. These results support body esteem as a mechanism that contributes to increased depression among girls in adolescence-despite a differential impact of pubertal timing for Caucasian and African American girls.

Stressful life events and depression symptoms: the effect of childhood emotional abuse on stress reactivity.

OBJECTIVE: Stressful life events are associated with an increase in depressive symptoms and the onset of major depression. Importantly, research has shown that the role of stress changes over the course of depression. The present study extends the current literature by examining the effects of early life stress on emotional reactivity to current stressors. METHOD: In a multiwave study (N = 281, mean age = 18.76; 68% female), we investigated the proximal changes that occur in depressive symptoms when individuals are faced with life stress and whether a history of childhood emotional abuse moderates this relationship. RESULTS: Results support the stress sensitivity hypothesis for early emotional abuse history. Individuals with greater childhood emotional abuse severity experienced greater increases in depressive symptoms when confronted with current dependent stressors, controlling for childhood physical and sexual abuse. CONCLUSIONS: This study highlights the importance of emotional abuse as an indicator for reactivity to stressful life events.

Emotional maltreatment, peer victimization, and depressive versus anxiety symptoms during adolescence: hopelessness as a mediator.

Extensive comorbidity between depression and anxiety has driven research to identify unique and shared risk factors. This study prospectively examined the specificity of three interpersonal stressors (emotional abuse, emotional neglect, and relationally oriented peer victimization) as predictors of depressive versus anxiety symptoms in a racially diverse community sample of adolescents. We expanded on past research by examining hopelessness as a mediator of the relationships between these interpersonal stressors and symptoms. Participants included 225 adolescents (55% African American; 59% female; M age = 12.84 years) who completed measures at baseline (Time 1) and two follow-up assessments (Times 2 and 3). Symptoms of depression and anxiety (social, physical, total) were assessed at Time 1 and Time 3, whereas intervening emotional maltreatment, peer victimization, and hopelessness were assessed at Time 2. Hierarchical linear regressions indicated that emotional abuse was a nonspecific predictor of increases in both depressive symptoms and symptoms of social, physical, and total anxiety, whereas relationally oriented peer victimization predicted depressive symptoms specifically. Emotional neglect did not predict increases in depressive or anxiety symptoms. In addition, hopelessness mediated the relationships between emotional abuse and increases in symptoms of depression and social anxiety. These findings suggest that emotional abuse and relationally oriented peer victimization are interpersonal stressors that are relevant to the development of internalizing symptoms in adolescence and that hopelessness may be one mechanism through which emotional abuse contributes to an increased risk of depression and social anxiety.

Internalizing symptoms and rumination: the prospective prediction of familial and peer emotional victimization experiences during adolescence.

Adolescence is marked by increases in stressful life events. Although research has demonstrated that depressed individuals generate stress, few studies investigate the generation of emotional victimization. The current study examined the effects of rumination and internalizing symptoms on experiences of peer victimization and familial emotional abuse. Participants were 216 adolescents (M = 14-years-old; 58% female; 47% African-American) who completed two assessments. Results showed that rumination predicted peer victimization and emotional abuse. The effect of rumination on emotional victimization is heightened for those who have higher levels of depression symptoms. That is, individuals who ruminate and who have depression symptoms experience increases in both peer emotional victimization and parental emotional abuse. This study builds upon prior research and indicates that rumination may be a stronger predictor of emotional victimization than symptoms of depression or anxiety. Identifying underlying mechanisms may yield targets for interventions aimed at addressing the chronic nature of depression.

Emotion regulation characteristics and cognitive vulnerabilities interact to predict depressive symptoms in individuals at risk for bipolar disorder: a prospective behavioural high-risk study.

Recent work has identified behavioural approach system (BAS) sensitivity as a risk factor for the first onset and recurrence of mood episodes in bipolar disorder, but little work has evaluated risk factors for depression in individuals at risk for, but without a history of, bipolar disorder. The present study evaluated cognitive styles and the emotion-regulatory characteristics of emotional clarity and ruminative brooding as prospective predictors of depressive symptoms in individuals with high versus moderate BAS sensitivity. Three separate regressions indicated that the associations between dysfunctional attitudes, self-criticism, and neediness with prospective increases in depressive symptoms were moderated by emotional clarity and brooding. Whereas brooding interacted with these cognitive styles to exacerbate their impact on depressive symptoms, emotional clarity buffered against their negative impact. These interactions were specific to high-BAS individuals for dysfunctional attitudes, but were found across the full sample for self-criticism and neediness. These results indicate that emotion-regulatory characteristics and cognitive styles may work in conjunction to confer risk for and resilience against depression, and that some of these relationships may be specific to individuals at risk for bipolar disorder.

Stress generation and exposure in a multi-wave study of adolescents: Transactional processes and sex differences.

Given considerable overlap among individual difference predictors of stress generation, the current study sought to elucidate which individual factors are uniquely involved in the stress generation process for interpersonal and achievement events among adolescents. Further, we examined transactional processes between stressors and depressive symptoms and explored potential sex differences in the unique prediction of stress generation. At baseline, youth (6th-10th graders, n=350, 57% female; 53% White) reported on various individual differences hypothesized to predict prospective increases in stressors. Youth also reported on depressive symptoms and stressors for 4 waves over 5 months. Multi-level modeling showed that different individual difference factors uniquely prospectively predicted increases in dependent (interpersonal and achievement) stressors. Central to this process was interpersonal vulnerabilities and psychopathology. Some of these predictions differed for boys and girls. In addition and in support of a transactional relationship between stressors and depressive symptoms, increases in stressors predicted prospective elevations in depressive symptoms for both boys and girls. This study provides support for the transactional nature of stress and depression in a multi-wave study of adolescence. This study demonstrates that particular individual factors are uniquely associated with the generation of stress, with some associations moderated by gender.

Emotional reactivity and exposure to household stress in childhood predict psychological problems in adolescence.

In recent years, research has examined the role of heightened emotional reactivity and poor regulation on maladjustment during childhood and adolescence. Although much of this research has shown a direct link between high emotional reactivity and maladjustment, there is less research on the ways in which reactivity interacts with contextual factors. Using data from the National Institute of Child Health & Human Development Study of Early Child Care and Youth Development (SECCYD), the current study asks how emotional reactivity in childhood, household chaos, and household income impact changes in emotional and behavioral problems between childhood and adolescence. Participants in the SECCYD were followed from birth until adolescence. Of these, 958 youth (52 % male; 80 % Caucasian, 13 % African American, 2 % Asian, and 5 % Other) who completed measures at age 15 were included in the current study. Results indicate that emotional reactivity and low household income during childhood directly predict higher levels of emotional and behavioral problems in adolescence. In contrast, the impact of household chaos on adolescent mental health depends on the child's emotional reactivity. Specifically, the adverse impact of household chaos on emotional problems was observed among adolescents who were highly emotionally reactive as children, but not among their less reactive counterparts. Taken together, the relationship between an individual's childhood context and temperament are important aspects in the prediction of outcomes in adolescents.

Cognitive vulnerabilities and depression versus other psychopathology symptoms and diagnoses in early adolescence.

We examined the concurrent associations between multiple cognitive vulnerabilities to depression featured in hopelessness theory, Beck's theory, and response styles theory and depressive symptoms and diagnoses in a sample of early adolescents. We also examined the specificity of these cognitive vulnerabilities to depression versus anxiety and externalizing psychopathology, controlling for co-occurring symptoms and diagnoses. Male and female, Caucasian and African American, 12- to 13-year-old adolescents were assessed in a cross-sectional design. Cognitive vulnerabilities of hopelessness, inferential style, rumination, and self-referent information processing were assessed with self-reports and behavioral tasks. Symptoms and diagnoses of depressive, anxiety, and externalizing disorders were assessed with self-report questionnaires and diagnostic interviews. Hopelessness exhibited the greatest specificity to depressive symptoms and diagnoses, whereas negative inferential styles, rumination, and negative self-referent information processing were associated with both depressive and anxiety symptoms and diagnoses and, in some cases, with externalizing disorders. Consistent with cognitive theories of depression, hopelessness, negative inferential styles, rumination, and negative self-referent information processing were associated with depressive symptoms and diagnoses. However, with the exception of hopelessness, most of the remaining cognitive vulnerabilities were not specific to depression. With further maturation of our sample, these cognitive vulnerabilities may become more specific to depression as cognitive styles further develop and consolidate, the rates of depression increase, and individuals' presentations of psychopathology become more differentiated.

Risk Factors for Depression in Adolescents With ADHD: The Impact of Cognitive Biases and Stress.

Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents (Mage = 14.42) with ADHD (n = 59) and without ADHD (n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.

Evaluating the combination of a Brief Motivational Intervention plus Cognitive Behavioral Therapy for Depression and heavy episodic drinking in college students.

[Correction Notice: An Erratum for this article was reported in Vol 34(2) of Psychology of Addictive Behaviors (see record 2020-16883-001). In the original article the order of authorship was incorrect. The correct second and third authors should appear instead as Brian Borsari and Jennifer E. Merrill.] Heavy episodic drinking (HED) and depressive symptoms often co-occur among college students and are associated with significant impairment. However, evidence-based treatments for these common co-occurring conditions are not available for college students. The current study compared the effectiveness of a treatment combining Cognitive-Behavioral Therapy for Depression and Brief Motivational Interviewing (CBT-D + BMI) versus Cognitive-Behavioral Therapy for Depression (CBT-D) alone among 94 college students with HED and depressive symptoms. Both treatment programs were associated with significant reductions of similar magnitude in HED, alcohol-related problems (ARP), and depressive symptoms at the end of treatment and at the 1-month follow-up assessment. Moderation analyses indicated that, among college students with fewer depressive symptoms at baseline, CBT-D was associated with greater sustained reduction in heavy drinking relative to CBT-D + BMI at the 1-month follow-up. Although the study did not include a no-treatment condition, the magnitude of improvement during treatment in both groups was greater than what is expected with passage of time. Although clinicians in college counseling centers may lack specialty training for co-occurring conditions, CBT-D is widely implemented in college settings. Our findings suggest that CBT-D may reduce both depressive symptoms and HED in college students and may be used to address a significant public health problem. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effects of Open-Label, Adjunctive Ganaxolone on Persistent Depression Despite Adequate Antidepressant Treatment in Postmenopausal Women: A Pilot Study.

OBJECTIVE: The neuroactive steroid metabolite of progesterone, allopregnanolone, is a positive allosteric modulator of γ-aminobutyric acid-A (GABAA) receptors and a putative treatment for mood disorders. This pilot study was performed to determine whether an oral allopregnanolone analog (ganaxolone) may be effective adjunctive therapy for persistent depression despite adequate antidepressant treatment in postmenopausal women. METHOD: Ten postmenopausal women (mean ± SD age: 62.8 ± 6.3 years; range, 53-69 years) with persistent depression despite adequate antidepressant treatment (current DSM-IV-TR major depressive episode per the Structured Clinical Interview for DSM-IV-TR, Montgomery-Asberg Depression Rating Scale [MADRS] score ≥ 16, and treated with an adequately dosed antidepressant for ≥ 6 weeks) were studied from December 2016 to April 2018. Open-label ganaxolone (225 mg twice daily, increased to 450 mg twice daily if tolerated) was administered for 8 weeks, followed by a 2-week taper. RESULTS: Mean ± SEM total MADRS score (primary endpoint) decreased by 8 weeks (24.4 ± 1.6 to 12.8 ± 2.9, P = .015), and the decrease persisted over the 2-week taper (P = .019); of the 9 subjects who completed the full 8-week treatment period, 44% (4/9) experienced response (MADRS score decrease ≥ 50%) and remission (final MADRS score < 10), which persisted in 100% and 50% of subjects at 10 weeks, respectively. Secondary endpoints showed significant improvement, including Inventory of Depressive Symptomatology-Self-Report score (P = .003), MADRS reduced sleep subscale score (P < .001), total Symptoms of Depression Questionnaire (SDQ) score (P = .012), and scores on SDQ subscales for disruptions in sleep quality (P = .003) and changes in appetite and weight (P = .009) over 8 weeks. No significant effects were observed on quality of life or sexual function. All subjects experienced sleepiness and fatigue; 60% experienced dizziness. CONCLUSIONS: In this open-label, uncontrolled pilot study, adjunctive ganaxolone appears to exert antidepressant effects but produces sedation with twice-daily dosing. Ganaxolone may also improve sleep, which may be useful in patients with depression and insomnia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02900092.

Low-Dose Testosterone Augmentation for Antidepressant-Resistant Major Depressive Disorder in Women: An 8-Week Randomized Placebo-Controlled Study.

OBJECTIVE: Low-dose testosterone has been shown to improve depression symptom severity, fatigue, and sexual function in small studies in women not formally diagnosed with major depressive disorder. The authors sought to determine whether adjunctive low-dose transdermal testosterone improves depression symptom severity, fatigue, and sexual function in women with antidepressant-resistant major depression. A functional MRI (fMRI) substudy examined effects on activity in the anterior cingulate cortex (ACC), a brain region important in mood regulation. METHODS: The authors conducted an 8-week randomized double-blind placebo-controlled trial of adjunctive testosterone cream in 101 women, ages 21-70, with antidepressant-resistant major depression. The primary outcome measure was depression symptom severity as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary endpoints included fatigue, sexual function, and safety measures. The primary outcome of the fMRI substudy (N=20) was change in ACC activity. RESULTS: The participants' mean age was 47 years (SD=14) and their mean baseline MADRS score was 26.6 (SD=5.9). Eighty-seven (86%) participants completed 8 weeks of treatment. MADRS scores decreased in both study arms from baseline to week 8 (testosterone arm: from 26.8 [SD=6.3] to 15.3 [SD=9.6]; placebo arm: from 26.3 [SD=5.4] to 14.4 [SD=9.3]), with no significant difference between groups. Improvement in fatigue and sexual function did not differ between groups, nor did side effects. fMRI results showed a relationship between ACC activation and androgen levels before treatment but no difference in ACC activation with testosterone compared with placebo. CONCLUSIONS: Adjunctive transdermal testosterone, although well tolerated, was not more effective than placebo in improving symptoms of depression, fatigue, or sexual dysfunction. Imaging in a subset of participants demonstrated that testosterone did not result in greater activation of the ACC.

Developmental origins of cognitive vulnerabilities to depression: review of processes contributing to stability and change across time.

Cognitive theories of depression have been shown to be potent predictors of future increases in depressive symptoms and disorder in children, adolescents, and adults. This article focuses on potential developmental origins of the main cognitive vulnerabilities, including dysfunctional attitudes, negative cognitive style, and rumination. We selectively review processes and factors that have been hypothesized to contribute to the emergence and stabilization of these cognitive risk factors. This review focuses on genetic factors, temperament, parents and peers as salient interpersonal influences, and stressful life events. We end with suggestions for future theory development and research. In particular, we emphasize the need for additional conceptual and empirical work integrating these disparate processes together into a coherent, developmental psychopathological model, and we highlight the coexistence of both stability and change in the development of cognitive vulnerabilities to depression across the lifespan.