Communication modality matters: Co-rumination via in-person versus digital modalities has different prospective associations with depression and friendship quality.

INTRODUCTION: Co-rumination is an interpersonal emotion regulation strategy in which negative feelings and problems are discussed perseveratively with another person. Although co-rumination is salient in adolescence, research to date has focused on co-rumination occurring in person and has not kept pace with the surge in digital communication that begins in adolescence. This study examined the degree, associations among, and consequences (i.e., depressive symptoms, and friendship quality) of adolescents' co-rumination via in-person, text, social media, and phone modalities. METHODS: Adolescents (n = 109; 51 girls, 57 boys, 1 nonbinary; Mage = 12.83 years) residing in Canada, completed self-report questionnaires on co-rumination, depressive symptoms, and friendship quality for up to 2 years. RESULTS: Adolescents engaged in co-rumination across all modalities, particularly in-person. Findings indicated a negative association between in-person co-rumination at baseline and in-person co-rumination over time. Whereas less text co-rumination was associated with increased depressive symptoms over time, greater phone co-rumination was associated with increased depressive symptoms over time. Although greater in-person co-rumination was positively associated with friendship quality concurrently, it was negatively associated with friendship quality prospectively. CONCLUSIONS: Taken together, co-rumination outcomes may vary depending on communication modality. Implications for adolescents' mental and social wellbeing are discussed.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents.

INTRODUCTION: Early adolescence represents a time of heightened vulnerability for depression. Negative interpretation biases have been associated with increases in depressive symptoms during this developmental period; however, the mechanisms underlying the association between interpretation biases and depression remain poorly understood. Cognitive theories posit that interpretation biases give rise to depression by modulating daily affect, particularly in the context of stress. However, this has not yet been directly examined. The present study tested affect intensity and instability as mechanisms linking negative interpretation biases with change in adolescent depressive symptoms. METHODS: Ninety-four adolescents (aged 11-13 years; 51% boys) from Vancouver, Canada, were recruited for this longitudinal study. At baseline (Time 1), participants self-reported depressive symptoms and completed the Scrambled Sentences Task to assess negative interpretation biases. Next, participants completed daily diaries to assess positive affect (PA) and negative affect (NA) during a naturalistic stressor-the first 2 weeks of high school (Time 2). Finally, participants self-reported depressive symptoms 3 months later (Time 3). Path models were conducted to test whether PA and NA intensity and instability mediated prospective associations between negative interpretation biases and depressive symptom changes. RESULTS: Although NA intensity, NA instability, and PA instability predicted increases in depressive symptoms, only NA intensity mediated associations between interpretation biases and symptom changes. Neither PA intensity nor instability mediated these associations. CONCLUSIONS: Elevated daily NA represents a specific mechanism through which stronger negative interpretation biases predict increases in depressive symptoms in adolescence.

Co-rumination across in-person and digital communication: Associations with affect and relationship closeness in adolescents.

INTRODUCTION: Despite the prominence of interpersonal emotion regulation, particularly during adolescence, it is a relatively understudied area of investigation. Co-rumination is an interpersonal emotion regulation strategy that is frequently used by adolescents. Traditional examinations of co-rumination have focused on its occurrence in person, while largely overlooking digital modes of communication. This study was the first to investigate adolescents' co-rumination across multiple communication modalities (i.e., in person, text, social media, phone) and its downstream association with affect and relationship closeness. Specifically, we examined: (1) the frequency of co-rumination across modalities, (2) the effect of co-rumination in one modality on the future use of co-rumination within that same modality (i.e., stability) and across other modalities (i.e., generalization); and (3) the prospective relation of co-rumination on negative affect, positive affect, and relationship closeness. METHODS: Adolescents (n = 71; 33 girls and 38 boys; Mage = 12.70 years) residing in Canada completed twice-daily diary surveys for 14 days. RESULTS: Findings indicated that adolescents co-ruminate across all modes of communication, particularly in person. There also was evidence of co-rumination stability and generalization over time for some modes of communication (within phone and from social media to in-person interactions), but not for others. Co-rumination through text and over the phone had affective and/or social benefits, whereas co-rumination through social media predicted diminished positive affect. We also identified ways these findings differed by gender. CONCLUSIONS: Implications for adolescents' emotional and social development and the field of co-rumination are discussed.

Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer.

Psychological factors may influence survival in breast cancer patients but results of previous research are inconclusive. This prospective population-based study tested whether depression predicts mortality in breast cancer patients. Routinely collected depression screening data were merged with electronically archived provincial cancer registry data and censored data from British Columbia Vital Statistics (extracted in December 2012). Cox proportional-hazards regression analyses were conducted to predict all-cause and breast cancer-specific mortality as a function of depression after controlling for biomedical confounders. Of 1,646 patients, 1,604 had breast cancer stages I-III and 42 had stage IV breast cancer. 176 (11.0 %) versus 28 (66.7 %) were deceased after a median follow-up of 76 months. In patients with curable breast cancer, depression predicted all-cause (HR = 1.54 (95 % CI 1.06-2.25); p = 0.024), but not breast cancer-specific mortality (HR = 1.51 (95 % CI 0.95-2.41); p = 0.084). No association was shown for metastatic disease. Stage-specific analyses demonstrated a 2-2.5-fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease, but not in patients with stage III or IV breast cancer. In stage I breast cancer patients, age moderated effects of depression such that depressed younger patients diagnosed at age 45 (i.e., mean age -1SD) showed a ninefold (HR = 9.82 (95 % CI 2.26-42.68); p = 0.002) increase in all-cause mortality and depressed patients at 57 a 3.7-fold (HR = 3.69 (95 % CI 1.44-9.48); p = 0.007) increase, while no association was evident in older patients at age 69 (mean age +1SD). Depression is strongly associated with mortality in younger patients with early stage breast cancer.

Measuring symptoms in gastrointestinal cancer: a systematic review of assessment instruments.

PURPOSE: It is critical for gastrointestinal cancer researchers and clinicians to have access to comprehensive, sensitive and simple-to-use symptom measures that allow them to understand and quantify the subjective patient experience. Development and validation of such scales requires training in psychometrics and occasionally uses technical jargon that can be difficult to penetrate. This review evaluates existing measures of gastrointestinal cancer symptoms, provides tool descriptions, and uses predefined, objective quality criteria to rate psychometric quality and facilitate tool choices for researchers and clinicians. METHODS: MEDLINE, EMBASE, CINAHL, and PsycINFO databases were systematically reviewed for scales assessing gastrointestinal cancer and gastrointestinal cancer site-specific symptoms. Evaluation criteria were the following: breadth of domain coverage (content validity), high internal consistency (α ≥ .80), sensitivity to change, and extent of validation. RESULTS: In n = 36 validation studies, 26 gastrointestinal cancer symptom measures were identified. Of these, n = 13 tools met criteria for recommendation, and six in particular showed strong psychometric properties. The Functional Assessment of Cancer Therapy-Colorectal (FACT-C), European Organization for Research and Treatment of Cancer (EORTC) gastric cancer module (QLQ-STO22), FACT-Hepatobiliary (FACT-Hep), and EORTC oesophagus, oesophago-gastric junction and stomach module (QLQ OG-25) were identified as the most comprehensive and best validated scales for each of the major gastrointestinal cancer sites. The FACT-Colorectal Symptom Index (FCSI-9) and the National Comprehensive Cancer Network (NCCN) FACT-Hepatobiliary Symptom Index (FHSI-18) were specifically validated in patients with advanced colorectal and liver cancer and also demonstrated superior psychometric properties. CONCLUSIONS: Several comprehensive, well-validated scales exist to adequately assess gastrointestinal cancer site-specific symptoms. Specifically, gastrointestinal cancer submodules of the FACT quality of life questionnaire represent adequate tool choices in most instances and overall, were better validated than the respective EORTC tools. Further improvement of existing, highly rated measures is recommended.

Patterns of respiratory sinus arrhythmia and trajectories of anxiety and depressive symptoms in early adolescence.

In children and adults, individual differences in patterns of respiratory sinus arrhythmia (RSA; i.e., interactions between resting RSA and RSA reactivity to stress) have emerged as a central predictor of internalizing symptoms. However, it is unclear whether individual differences in patterns of RSA also contribute to internalizing symptoms during the key developmental period of early adolescence, when rates of internalizing symptoms sharply increase. In the present multi-wave longitudinal study, we assessed whether patterns of RSA predicted trajectories of the two most common types of internalizing symptoms among adolescents: anxiety and depression. In the baseline session, we assessed RSA at rest and in response to a psychosocial stressor (Trier Social Stress Test [TSST]) in a sample of 75 early adolescents (Mage = 12.85). Youth then completed measures of anxiety and depressive symptoms at baseline and four times over approximately two years. Findings indicate that RSA patterns predicted trajectories of anxiety, but not depression. Specifically, region of significance analyses indicated that individuals with high resting RSA who demonstrated RSA augmentation to the lab stressor evinced decreasing anxiety over the follow-up period. In direct contrast, adolescents with high resting RSA in combination with RSA withdrawal to the stressor exhibited a trajectory of increasing anxiety. Findings provide preliminary evidence for understanding RSA as a developmentally salient risk or protective factor.

Osteocalcin: A novel biomarker of adolescent psychopathology.

Osteocalcin is a bone-derived hormone implicated in the acute stress response and recently linked to adult depression. Yet it is unclear whether osteocalcin is a biomarker of other forms of psychopathology and whether osteocalcin-psychopathology associations emerge during developmentally sensitive periods earlier in life. Thus, in the current pilot study we examined salivary osteocalcin and psychiatric symptoms and disorders among 48 early adolescents during a period of stress. A logistic regression indicated lower osteocalcin was associated with meeting criteria for a psychiatric disorder, OR = 0.43, 95 % CI [.002,.924], and showed moderate-to-large cross-sectional associations with a range of elevated psychopathology symptoms, Bs ≥ |-3.44|, ps ≤.034. Multilevel linear growth models indicated that low osteocalcin prospectively predicted an even greater range of psychopathology symptoms at one-year follow-up as well as increases in some symptoms over time, Bs ≥ |-1.83|, ps ≤.021. Findings introduce osteocalcin as a biomarker of diverse forms of psychopathology in youth. Osteocalcin is a potential transdiagnostic mechanism through which dysregulated responses to stress could cause or exacerbate various types of psychopathology, highlighting a promising target for clinical assessment and early intervention.

Dimensions of early life adversity and cognitive processing of emotion in youth.

BACKGROUND: Early life adversity (ELA) is a leading risk factor for psychopathology. The Dimensional Model of Adversity and Psychopathology (DMAP) elucidates processes altered by ELA and central to this association. Specifically, DMAP posits early experiences of deprivation alter cognitive and emotional processes in ways distinct from early experiences of threat. While evidence suggests that deprivation and threat predict alterations in cognitive and emotional processes, respectively, the influence of these dimensions on cognitive processing across emotionally valenced material remains unexamined. OBJECTIVE: This work is the first to investigate associations of deprivation versus threat on cognitive processing of multiple emotions (happy, sad, angry, and neutral facial expressions) and the time course of processing in a sample of youth. PARTICIPANTS AND SETTING: Eighty-two youth (48.80 % female, Mage = 12.85) were recruited from Vancouver. METHODS: Deprivation and threat were measured using the Traumatic Events Screening Inventory for Children (TESI-C), an interview-based measure assessing the instance and severity of 30+ experiences of ELA. Cognitive processing was measured using the Affective Posner Task, which assesses attentional biases and raw reaction times for happy, sad, angry, and neutral facial expressions. RESULTS: Interestingly, experiences of deprivation were associated with early attentional processing deficits regardless of valence, rs ≥ 0.22, ps ≤ 0.046, whereas experiences of threat were associated with late attentional biases for emotional material, Bs ≥ |4.15|, ps ≤ 0.036. CONCLUSIONS: Findings advance theoretical models of ELA by elucidating the nature and time course of cognitive and emotional alterations following deprivation and threat, and, if replicated, suggest the importance of cognitive processing of emotion in early interventions.

Attentional Biases and their Push and Pull with Rumination and Co-Rumination is Based on Depressive Symptoms: a Prospective Study of Adolescents.

Emotion regulation (ER) is central to adolescent mental health and wellbeing. However, the mechanisms underlying two common ER strategies - rumination and its interpersonal counterpart, co-rumination - are insufficiently understood in youth. Past research has documented that attentional disengagement biases are associated with rumination in adults, particularly among individuals with elevated depressive symptoms. Extending this line of research, the current study investigated whether attentional disengagement biases predicted rumination and co-rumination in adolescents based on their symptoms of depression. Using a multi-wave prospective design, 91 early adolescents (47% female, Mage = 12.87) completed a measure of depressive symptoms and the Affective Posner Task to assess early and late attentional processes at baseline. Adolescents also completed measures of rumination and co-rumination at baseline and every 3-months for one year. A multivariate means-as-outcomes multilevel model indicated that early disengagement biases for sad and happy faces interacted with depressive symptoms to predict later rumination and co-rumination. Critically, the direction of findings across rumination and co-rumination differed based on depressive symptoms. Results are the first to delineate a distinct pattern of attentional disengagement biases that predict rumination versus co-rumination in early adolescents. Findings extend theoretical conceptualizations of rumination to youth and provide the first account of cognitive mechanisms underlying co-rumination.

Discordance Indices of Stress Sensitivity and Trajectories of Internalizing Symptoms in Adolescence.

Psychiatric illness in adolescence is associated with long-term impairments, making it critical to identify predictors of adolescent psychiatric distress. Individual differences in stress sensitivity could be associated with longitudinal trajectories of internalizing symptoms. Historically, researchers have operationalized stress sensitivity by assessing either objective or subjective responses to stress. However, we posit that the relative discordance between subjective and objective responses to stress is a critical metric of stress sensitivity. We examined whether two discordance-based indices of stress sensitivity were related to one another and to trajectories of internalizing psychopathology among a sample of 101 adolescent youths (Mage = 12.80 at baseline; 55% males) across two successive stressors: the high school transition and the COVID-19 pandemic. Using latent growth curve modeling, we found that greater discordance between subjective (i.e., affective) and objective (i.e., cortisol) responses to a social-evaluative stressor was associated with higher internalizing symptoms at baseline and an accelerated symptom growth trajectory across the first year of the pandemic. In contrast, early life stress sensitivity was not associated with internalizing symptoms. Findings suggest that the discordance between objective and subjective experiences of social-evaluative stress predicts a pernicious growth trajectory of internalizing symptoms during adolescence. This work advances current methodologies, contributes to theoretical models of internalizing psychopathology, and with replication could have implications for policy and practice by identifying a key vulnerability factor that increases adolescents' psychiatric distress over time.

Interpersonal emotion regulation flexibility: Effects on affect in daily life.

Although the emotion regulation (ER) literature is vast, two emerging areas are particularly noteworthy. First, as opposed to the traditional blanket characterization of ER strategies as adaptive or maladaptive, theoretical models have highlighted the adaptability of greater ER flexibility (i.e., flexibly implementing ER strategies based on the context). Second, instead of focusing on how individuals independently regulate emotions, researchers are increasingly examining how ER can occur with the help of another person, a process known as interpersonal emotion regulation (IER). This study is the first to integrate these two emerging areas of research and to apply the two main theories of ER flexibility to investigate the effect of IER flexibility on negative and positive affect. A sample of 384 adults (Mage = 38.58 years, SD = 13.82) residing predominantly in North America completed this 14-day daily diary study. As expected, greater repertoire and greater responsivity to feedback were associated with more adaptive affective outcomes (i.e., less negative affect and/or more positive affect). However, unexpected findings also emerged: Greater context sensitivity did not significantly predict affect, and the covariation of within-strategy variability and environmental variability predicted higher negative affect. Findings provide initial evidence that IER adaptiveness is influenced by one's ability to flexibly implement IER strategies (i.e., IER flexibility). The results also highlight the components of IER flexibility (namely greater repertoire and responsivity to feedback) that predict daily adaptive affective consequences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Advances in stress and depression research.

PURPOSE OF REVIEW: Stress plays a central role in the onset and course of depression. However, only a subset of people who encounter stressful life events go on to experience a depressive episode. The current review highlights recent advances in understanding when, why, and for whom the stress-depression link occurs, and we identify avenues for future research. RECENT FINDINGS: In the last 18 months, researchers have taken a more nuanced perspective on the biopsychosocial mechanisms critical to the stress-depression link. For example, examination of specific facets of emotion regulation, including emotion regulation flexibility and interpersonal emotion regulation, has been critical to understanding its role in depression. Similarly, refined investigations of social support allowed researchers to identify distinct - and occasionally opposite - outcomes depending on the context or manner in which the support was provided. Researchers also documented that the stress-depression link was enhanced by dysregulation of several stress-sensitive biological systems, such as the immune system, microbiome, endocrine system, and neuroanatomical substrates. SUMMARY: Recent studies highlight the importance of adopting a nuanced understanding of mechanisms and moderators that explain the stress-depression link. We also encourage continued engagement in collaborative, open science that uses multiple methods to study the full breadth of human diversity.

Risk and protective factors for stress generation: A meta-analytic review.

The stress generation hypothesis suggests that some individuals contribute more than others to the occurrence of dependent (self-generated), but not independent (fateful), stressful life events. This phenomenon is commonly studied in relation to psychiatric disorders, but effects are also driven by underlying psychological processes that extend beyond the boundaries of DSM-defined entities. This meta-analytic review of modifiable risk and protective factors for stress generation synthesizes findings from 70 studies with 39,693 participants (483 total effect sizes) from over 30 years of research. Findings revealed a range of risk factors that prospectively predict dependent stress with small-to-moderate meta-analytic effects (rs = 0.10-0.26). Negligible to small effects were found for independent stress (rs = 0.03-0.12), and, in a critical test for stress generation, most effects were significantly stronger for dependent compared to independent stress (ßs = 0.04-0.15). Moderation analyses suggest effects of maladaptive interpersonal emotion regulation behaviors and repetitive negative thinking are stronger for interpersonal (versus non-interpersonal) stress; effects of repetitive negative thinking and excessive standards for self may be inflated by overreliance on self-report measures that fail to isolate psychological distress from objective experience. Findings have key implications for advancing stress generation theory and informing targets for intervention.

The vicious cycle of psychopathology and stressful life events: A meta-analytic review testing the stress generation model.

Stress generation theory initially posited that depression elevates risk for some stressful events (i.e., dependent events) but not others (i.e., independent events). This preregistered meta-analytic review examined whether stress generation occurs transdiagnostically by examining 95 longitudinal studies with 38,228 participants (537 total effect sizes) from over 30 years of research. Our multilevel meta-analyses found evidence of stress generation across a broad range of psychopathology, as evidenced by significantly larger prospective effects for dependent (overall psychopathology: r = .23) than independent (overall psychopathology: r = .10) stress. We also identified unique patterns of effects across specific types of psychopathology. For example, effects were larger for depression than anxiety. Furthermore, effects were sometimes larger in studies with younger participants, shorter time lags between assessments, checklist measures of stress, and for interpersonal stressors. Finally, a multilevel meta-analytic structural equation model suggested that dependent stress exacerbates psychopathology symptoms over time (ß = .04), possibly contributing to chronicity. Interventions targeting the prevention of stress generation may mitigate chronic psychopathology. Conclusions of this study are limited by the predominance of depression effect sizes in the literature and our review of only English language articles. On the other hand, the findings are strengthened by rigorous inclusion criteria, lack of publication bias, and absence of moderating effects by publication year. The latter underscores the replicability of the stress generation effect over the last 30 years. Taken together, the review provides robust evidence that stress generation is a cross-diagnostic phenomenon that contributes to a vicious cycle of increasing stress and psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predicting recurrence of major depressive episodes using the Depression Implicit Association Test: A Canadian biomarker integration network in depression (CAN-BIND) report.

Identifying clinically relevant predictors of depressive recurrence following treatment for Major Depressive Disorder (MDD) is critical for relapse prevention. Implicit self-depressed associations (SDAs), defined as implicit cognitive associations between elements of depression (e.g., sad, miserable) and oneself, often persist following depressive episodes and may represent a cognitive biomarker for future recurrences. Thus, we examined whether SDAs, and changes in SDAs over time, prospectively predict depressive recurrence among treatment responders in the CAN-BIND Wellness Monitoring for MDD Study, a prospective cohort study conducted across 5 clinical centres. A total of 96 patients with MDD responding to various treatments were followed an average of 1.01 years. Participants completed the Depression Implicit Association Test (DIAT) - a computer-based measure of SDAs - every 8 weeks on a tablet device. Survival analyses indicated that greater SDAs at baseline and increases in SDAs over time predicted shorter time to MDD recurrence, even after accounting for depressive symptom severity. The findings show that SDAs are a robust prognostic indicator of risk for MDD recurrence, and that the DIAT may be a feasible and low-cost clinical screening tool. SDAs also represent a potential mechanism underlying the course of recurrent depression and are a promising target for relapse prevention interventions.

Emotion regulation and diurnal cortisol: A longitudinal study of early adolescents.

Aberrant patterns of diurnal cortisol, a marker of stress reactivity, predict adverse physical and mental health among adolescents. However, the mechanisms underlying aberrant diurnal cortisol production are poorly understood. Thus, the objective of this study was to investigate, for the first time, whether the core emotion regulation (ER) strategies of rumination (brooding, reflection), reappraisal, and suppression were prospectively associated with individual differences in diurnal cortisol during the COVID-19 pandemic, a period of significant stress. A community sample of 48 early adolescents (Mage = 13.45; 60% males) was recruited from British Columbia, Canada. Participants completed ER measures before the pandemic, and diurnal cortisol was assessed by collecting eight saliva samples over two days during the first COVID-19-related lockdown in the region. As expected, brooding predicted elevated waking cortisol and a blunted cortisol awakening response (CAR), whereas reflection predicted lower waking cortisol and suppression predicted a steeper CAR. Unexpectedly, reappraisal was not associated with diurnal cortisol production. Results indicate that ER strategies may represent a mechanism underlying individual differences in biological markers of wellbeing during stress.

The Association of Emotion Regulation Flexibility and Negative and Positive Affect in Daily Life.

In contrast to traditional classifications of emotion regulation (ER) strategies as either uniformly maladaptive or adaptive, recent theoretical models emphasize that adaptability is determined by greater ER flexibility (i.e., the ability to flexibly implement and adjust ER strategies based on the context). This study is the first to empirically test the two central perspectives of ER flexibility on affect. A sample of 384 adults (M age=38.58 years, SD=13.82) residing predominantly in North America completed daily diaries for 14 days. We found evidence that theoretical components of ER flexibility, as defined by greater context sensitivity in the selection of ER strategies, greater ER strategy repertoire, enhanced responsivity to affective feedback, and ER-environmental covariation, were associated with adaptive affective outcomes (i.e., reduced negative affect and/or increased positive affect). This study highlights the importance of examining ER flexibility and its consequences as a critical component of ER. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00132-7.

Influence of Gender and Self-Perceived Competence on Psychological Well-Being in Adolescent and Young Adult Cancer Survivors.

Elucidating factors associated with mental health and well-being among adolescent and young adult cancer survivors (AYAs) is increasingly important as this population continues to grow. Adolescence and young adulthood are critical times for developing self-perceived competencies (SPCs), which may be shaped by the cancer experience and may have different consequences based on the person's gender. We assessed whether gender moderated the association between perceived competencies and mental health in 61 AYAs (51% males; 11-20 years old; diagnosed between 0.33 and 17.33 years old). Gender moderated the association of SPC in close friendship, job, and scholastic domains with depression, anxiety, and optimism.

Impact of loneliness on diurnal cortisol in youth.

Loneliness is associated with multiple forms of psychopathology in youth. However, we do not yet know how loneliness gets "under the skin" in ways that may impact the long-term health and development of early adolescents. In particular, loneliness may influence youths' patterns of diurnal cortisol, an index of hypothalamic-pituitary-adrenal (HPA) axis functioning and a central predictor of health across the lifespan. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, or COVID-19) pandemic represents a salient period in which to study the consequences of loneliness, as recent work has provided evidence that the physical-distancing measures put in place to contain the virus have resulted in greater loneliness, particularly among youth. Thus, the current study aimed to examine the prospective association between loneliness during the COVID-19 pandemic and diurnal cortisol in early adolescents. We found that greater loneliness was associated with higher levels of cortisol at waking and a blunted cortisol awakening response (CAR). These results held even when controlling for covariates that can influence diurnal trajectories of cortisol. Critically, this pattern of HPA-axis functioning increases risk for adverse mental and physical health outcomes across adolescence and into adulthood. This study is the first to examine the prospective association between loneliness and diurnal cortisol in early adolescence, and the first to identify mechanisms that contribute to biological markers of distress during the COVID-19 pandemic. Findings underscore the importance of developing and distributing strategies to mitigate feelings of loneliness among youth.

Association between discrepancy in objective and subjective cognitive abilities and treatment response in patients with major depressive disorder: A CAN-BIND-1 study report.

BACKGROUND: Major Depressive Disorder (MDD) is characterized by objective and subjective cognitive deficits. Discrepancies between objective and subjective cognitive performance can reflect under- to over-estimations of cognitive abilities, and these discrepancies are referred to as cognitive self-appraisals. Despite evidence that low self-appraisals are associated with depression, the modifiability of self-appraisals and their association with treatment outcome remains unclear. The current study examined whether self-appraisals change following antidepressant treatment. Furthermore, we investigated the association of self-appraisals with treatment outcome. METHODS: As part of the CAN-BIND-1 clinical trial, 154 patients with MDD completed measures of objective and subjective cognitive abilities, depressive symptoms, and functional outcomes (work productivity, psychosocial functioning, and quality of life) at baseline and post-escitalopram treatment. Self-appraisals were calculated based on discrepancies between objective and subjective cognitive abilities, with higher scores indicating overestimation of cognitive abilities. RESULTS: Baseline self-appraisals were not predictive of treatment outcomes. However, self-appraisals increased from pre- to post-treatment. Moreover, pre-post treatment increases in self-appraisals were associated with positive treatment response and remission, decreases in depressive symptoms, and improvements in work productivity, psychosocial functioning, and quality of life. LIMITATIONS: The pre-post intervention design precluded examining the temporal precedence of change in self-appraisals versus depressive symptoms and functional outcomes. CONCLUSIONS: Findings are the first to demonstrate that self-appraisals are treatment-sensitive and are associated with treatment outcomes and recovery from MDD. Cognitive self-appraisals may represent a key marker of treatment response and a valuable target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.