Maternal depression, parental attributions, and adolescent psychopathology: An evaluation using observational and video-mediated recall methods.

Parenting styles associated with maternal depression are a risk factor for adolescent psychopathology, and maternal attributional styles may be a key mechanism in this relationship. Mother-adolescent dyads (N = 180; 96 male; ages 10-15) completed in-person interactions and then the mothers participated in a video-mediated recall procedure to assess maternal attributions. Maternal depression was associated with negative attributions. Negative attributions were associated with low parental acceptance, aggressive parenting, and low positive parenting. Positive maternal attributions were associated with less aggressive parenting, and more positive parenting during one interaction task. Adolescent externalizing behaviors were associated with negative attributions. Future research should evaluate whether maternal attributions mediate the association between maternal depression and both parenting behaviors and adolescent mental health.

Language Use in Mother-Adolescent Dyadic Interaction: Preliminary Results.

This preliminary study applied a computer-assisted quantitative linguistic analysis to examine the effectiveness of language-based classification models to discriminate between mothers (n = 140) with and without history of treatment for depression (51% and 49%, respectively). Mothers were recorded during a problem-solving interaction with their adolescent child. Transcripts were manually annotated and analyzed using a dictionary-based, natural-language program approach (Linguistic Inquiry and Word Count). To assess the importance of linguistic features to correctly classify history of depression, we used Support Vector Machines (SVM) with interpretable features. Using linguistic features identified in the empirical literature, an initial SVM achieved nearly 63% accuracy. A second SVM using only the top 5 highest ranked SHAP features improved accuracy to 67.15%. The findings extend the existing literature base on understanding language behavior of depressed mood states, with a focus on the linguistic style of mothers with and without a history of treatment for depression and its potential impact on child development and trans-generational transmission of depression.

Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis.

Importance: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. Objective: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. Data Sources: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. Study Selection: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. Data Extraction and Synthesis: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. Main Outcomes and Measures: Patient Health Questionnaire-9 (PHQ-9) scores. Results: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9. Conclusions and Relevance: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.

Human-Guided Modality Informativeness for Affective States.

This paper studies the hypothesis that not all modalities are always needed to predict affective states. We explore this hypothesis in the context of recognizing three affective states that have shown a relation to a future onset of depression: positive, aggressive, and dysphoric. In particular, we investigate three important modalities for face-to-face conversations: vision, language, and acoustic modality. We first perform a human study to better understand which subset of modalities people find informative, when recognizing three affective states. As a second contribution, we explore how these human annotations can guide automatic affect recognition systems to be more interpretable while not degrading their predictive performance. Our studies show that humans can reliably annotate modality informativeness. Further, we observe that guided models significantly improve interpretability, i.e., they attend to modalities similarly to how humans rate the modality informativeness, while at the same time showing a slight increase in predictive performance.

Minding the Gatekeepers: Referral and Recruitment of Postpartum Mothers with Depression into a Randomized Controlled Trial of a Mobile Internet Parenting Intervention to Improve Mood and Optimize Infant Social Communication Outcomes.

Mothers in the United States (U.S.) who are of non-dominant culture and socioeconomically disadvantaged experience depression during postpartum at a rate 3 to 4 times higher than mothers in the general population, but these mothers are least likely to receive services for improving mood. Little research has focused on recruiting these mothers into clinical intervention trials. The purpose of this article is to report on a study that provided a unique context within which to view the differential success of three referral approaches (i.e., community agency staff referral, research staff referral, and maternal self-referral). It also enabled a preliminary examination of whether the different strategies yielded samples that differed with regard to risk factors for adverse maternal and child outcomes. The examination took place within a clinical trial of a mobile intervention for improving maternal mood and increasing parent practices that promote infant social communication development. The sample was recruited within the urban core of a large southern city in the U.S. and was comprised primarily of mothers of non-dominant culture, who were experiencing severe socioeconomic disadvantage. Results showed that mothers self-referred at more than 3.5 times the rate that they were referred by either community agency staff or research staff. Moreover, compared to women referred by research staff, women who self-referred and those who were referred by community gatekeepers were as likely to eventually consent to study participation and initiate the intervention. Results are discussed with regard to implications for optimizing referral into clinical intervention trials.

Exploratory Factor Analysis of Observational Parent-Child Interaction Data.

The majority of studies using observational coding systems for family interaction data derive scales describing family members' behaviors based on rational/theoretical approaches. This study explored an empirical approach to identifying the component structure of parent-child observational data that incorporated the affective context of the interaction. Dyads of 155 typically developing 8-year-olds and their mothers completed questionnaires and two interaction tasks, one each designed to illicit positive and negative interactions. Behaviors were coded based on a modified version of the Family Interaction Macro-coding System. Multiple factor analysis identified four-component solutions for the maternal and child data. For both, two of the components included negative behaviors, one positive behavior, and one communicative behavior. Evidence for the validity of the maternal and child components was demonstrated by associations with child depression and anxiety symptoms and behavioral problems. Preliminary evidence supports an empirical approach to identify context-specific components in parent-child observational data.

Positive affect between close friends: Brain-behavior associations during adolescence.

Identifying the neural correlates of positive interactions between friendship dyads may provide insights into mechanisms associated with adolescent social development. Forty-eight 14- to 18-year-old typically developing adolescents were video-recorded discussing a shared positive event with a close friend and subsequently viewed clips during an fMRI scan of that friend during the interaction and of an unfamiliar peer in a similar interaction. Adolescents also reported on their positive affect in daily life while with friends using ecological momentary assessment. We used multivariate repeated measures models to evaluate how positive affect with friends in the laboratory and in daily life was associated with neural response to friend and stranger positive and neutral clips. Adolescents who exhibited more positive affect when with friends in the laboratory showed less dorsolateral prefrontal cortex to friend positive clips. More positive affect when with friends in daily life was associated with less bilateral anterior insula response to friend positive clips, but greater left anterior insula response to stranger positive clips. Findings provide information on the role of lateral prefrontal cortex and anterior insula in enjoyment of friendships during adolescence.

Sometimes It's Good to be Short: The Serotonin Transporter Gene, Positive Parenting, and Adolescent Depression.

In threatening environments, the short (S) allele of 5-HTTLPR is proposed to augment risk for depression. However, it is unknown whether 5-HTTLPR variation increases risk for depression in environments of deprivation, lacking positive or nurturant features. Two independent longitudinal studies (n = 681 and 176, respectively) examined whether 5-HTTLPR moderated associations between low levels of positive parenting at 11-13 years and subsequent depression at 17-19 years. In both studies only LL homozygous adolescents were at greater risk for depression with decreasing levels of positive parenting. Thus, while the S allele has previously been identified as a susceptible genotype, these findings suggest that the L allele may also confer sensitivity to depression in the face of specific environmental challenges.

Mediation analyses of Internet-facilitated cognitive behavioral intervention for maternal depression.

This study evaluated the putative mediating mechanisms of an Internet-facilitated cognitive-behavioral therapy (CBT) intervention for depression tailored to economically disadvantaged mothers of preschool-age children. The CBT mediators were tested across two previously published randomized controlled trials which included the same measures of behavioral activation, negative thinking, and savoring of positive events. Trial 1 included 70 mothers with elevated depressive symptoms who were randomized to either the eight-session, Internet-facilitated intervention (Mom-Net) or to treatment as usual. Trial 2 included 266 mothers with elevated depressive symptoms who were randomized to either Mom-Net or to a motivational interviewing and referral to services condition. Simple mediation models tested each putative mediator independently followed by tests of multiple mediation that simultaneously included all three mediators in the model to assess the salient contributions of each mediator. The pattern of results for the mediating effects were systematically replicated across the two trials and suggest that behavioral activation and negative thinking are salient mediators of the Mom-Net intervention; significant mediating effects for savoring were obtained only in the simple mediation models and were not obtained in the multiple mediation models.

Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis.

Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

Affective family interactions and their associations with adolescent depression: A dynamic network approach.

The prevalence of depression rises steeply during adolescence. Family processes have been identified as one of the important factors that contribute to affect (dys)regulation during adolescence. In this study, we explored the affect expressed by mothers, fathers, and adolescents during a problem-solving interaction and investigated whether the patterns of the affective interactions differed between families with depressed adolescents and families with nondepressed adolescents. A network approach was used to depict the frequencies of different affects, concurrent expressions of affect, and the temporal sequencing of affective behaviors among family members. The findings show that families of depressed adolescents express more anger than families of nondepressed adolescents during the interaction. These expressions of anger co-occur and interact across time more often in families with a depressed adolescent than in other families, creating a more self-sustaining network of angry negative affect in depressed families. Moreover, parents' angry and adolescents' dysphoric affect follow each other more often in depressed families. Taken together, these patterns reveal a particular family dynamic that may contribute to vulnerability to, or maintenance of, adolescent depressive disorders. Our findings underline the importance of studying affective family interactions to understand adolescent depression.

Systematic Review and Meta-analysis of Adolescent Cognitive-Behavioral Sleep Interventions.

This systematic review and meta-analysis examined the efficacy of adolescent cognitive-behavioral sleep interventions. Searches of PubMed, PsycINFO, CENTRAL, EMBASE, and MEDLINE were performed from inception to May 1, 2016, supplemented with manual screening. Nine trials were selected (n = 357, mean age = 14.97 years; female = 61.74%). Main outcomes were subjective (sleep diary/questionnaire) and objective (actigraphy) total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). There were a small number of randomized controlled trials (RCTs; n = 4) and a high risk of bias across the RCTs; therefore, within sleep condition meta-analyses were examined (n = 221). At post-intervention, subjective TST improved by 29.47 min (95% CI 17.18, 41.75), SOL by 21.44 min (95% CI -30.78, -12.11), SE by 5.34% (95% CI 2.64, 8.04), and WASO by a medium effect size [d = 0.59 (95% CI 0.36, 0.82)]. Objective SOL improved by 16.15 min (95% CI -26.13, -6.17) and SE by 2.82% (95% CI 0.58, 5.07). Global sleep quality, daytime sleepiness, depression, and anxiety also improved. Gains were generally maintained over time. Preliminary evidence suggests that adolescent cognitive-behavioral sleep interventions are effective, but further high-quality RCTs are needed. Suggestions for further research are provided.

Mom-net: Evaluation of an internet-facilitated cognitive behavioral intervention for low-income depressed mothers.

OBJECTIVE: Evaluate an Internet-facilitated cognitive-behavioral treatment intervention for depression, tailored to economically disadvantaged mothers of young children. METHOD: Economically disadvantaged mothers (N = 266) of preschool aged children, who reported elevated levels of depressive symptoms, were randomized to either the 8-session, Internet-facilitated intervention (Mom-Net) or to Motivational Interviewing and Referral to Services (MIRS). Outcomes were measured using the Patient Health Questionnaire 9 (PHQ-9; Spitzer et al., 1999), the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR) Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 2002), and the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960). RESULTS: Relative to participants in the MIRS condition, participants in Mom-Net demonstrated significantly greater reduction in depression as indexed by self-report questionnaire (primary outcome), interviewer-rated symptoms, and diagnostic outcomes. CONCLUSIONS: Results suggest that the Mom-Net intervention is effective as a remotely delivered intervention for economically disadvantaged mothers. (PsycINFO Database Record

Parental autonomy granting and child perceived control: effects on the everyday emotional experience of anxious youth.

BACKGROUND: Childhood anxiety is associated with low levels of parental autonomy granting and child perceived control, elevated child emotional reactivity and deficits in child emotion regulation. In early childhood, low levels of parental autonomy granting are thought to decrease child perceived control, which in turn leads to increases in child negative emotion. Later in development, perceived control may become a more stable, trait-like characteristic that amplifies the relationship between parental autonomy granting and child negative emotion. The purpose of this study was to test mediation and moderation models linking parental autonomy granting and child perceived control with child emotional reactivity and emotion regulation in anxious youth. METHODS: Clinically anxious youth (N = 106) and their primary caregivers were assessed prior to beginning treatment. Children were administered a structured diagnostic interview and participated in a parent-child interaction task that was behaviorally coded for parental autonomy granting. Children completed an ecological momentary assessment protocol during which they reported on perceived control, emotional reactivity (anxiety and physiological arousal) and emotion regulation strategy use in response to daily negative life events. RESULTS: The relationship between parental autonomy granting and both child emotional reactivity and emotion regulation strategy use was moderated by child perceived control: the highest levels of self-reported physiological responding and the lowest levels of acceptance in response to negative events occurred in children low in perceived control with parents high in autonomy granting. Evidence for a mediational model was not found. In addition, child perceived control over negative life events was related to less anxious reactivity and greater use of both problem solving and cognitive restructuring as emotion regulation strategies. CONCLUSION: Both parental autonomy granting and child perceived control play important roles in the everyday emotional experience of clinically anxious children.

Linking the serotonin transporter gene, family environments, hippocampal volume and depression onset: A prospective imaging gene × environment analysis.

A single imaging gene-environment (IGxE) framework that is able to simultaneously model genetic, neurobiological, and environmental influences on psychopathology outcomes is needed to improve understanding of how complex interrelationships between allelic variation, differences in neuroanatomy or neuroactivity, and environmental experience affect risk for psychiatric disorder. In a longitudinal study of adolescent development we demonstrate the utility of such an IGxE framework by testing whether variation in parental behavior at age 12 altered the strength of an imaging genetics pathway, involving an indirect association between allelic variation in the serotonin transporter gene to variation in hippocampal volume and consequent onset of major depressive disorder by age 18. Results were consistent with the presence of an indirect effect of the serotonin transporter S-allele on depression onset via smaller left and right hippocampal volumes that was significant only in family environments involving either higher levels of parental aggression or lower levels of positive parenting. The previously reported finding of S-allele carriers' increased risk of depression in adverse environments may, therefore, be partly because of the effects of these environments on a neurobiological pathway from the serotonin transporter gene to depression onset that proceeds through variation in hippocampal volume.

INFERRING CLINICAL DEPRESSION FROM SPEECH AND SPOKEN UTTERANCES.

In this paper, we investigate the problem of detecting depression from recordings of subjects' speech using speech processing and machine learning. There has been considerable interest in this problem in recent years due to the potential for developing objective assessments from real-world behaviors, which may provide valuable supplementary clinical information or may be useful in screening. The cues for depression may be present in "what is said" (content) and "how it is said" (prosody). Given the limited amounts of text data, even in this relatively large study, it is difficult to employ standard method of learning models from n-gram features. Instead, we learn models using word representations in an alternative feature space of valence and arousal. This is akin to embedding words into a real vector space albeit with manual ratings instead of those learned with deep neural networks [1]. For extracting prosody, we employ standard feature extractors such as those implemented in openSMILE and compare them with features extracted from harmonic models that we have been developing in recent years. Our experiments show that our features from harmonic model improve the performance of detecting depression from spoken utterances than other alternatives. The context features provide additional improvements to achieve an accuracy of about 74%, sufficient to be useful in screening applications.

Maternal parenting behaviors and adolescent depression: the mediating role of rumination.

Substantial evidence suggests that rumination is an important vulnerability factor for adolescent depression. Despite this, few studies have examined environmental risk factors that might lead to rumination and, subsequently, depression in adolescence. This study examined the hypothesis that an adverse family environment is a risk factor for rumination, such that the tendency to ruminate mediates the longitudinal association between a negative family environment and adolescent depressive symptoms. It also investigated adolescent gender as a moderator of the relationship between family environment and adolescent rumination. Participants were 163 mother-adolescent dyads. Adolescents provided self-reports of depressive symptoms and rumination across three waves of data collection (approximately at ages 12, 15, and 17 years). Family environment was measured via observational assessment of the frequency of positive and aggressive parenting behaviors during laboratory-based interactions completed by mother-adolescent dyads, collected during the first wave. A bootstrap analysis revealed a significant indirect effect of low levels of positive maternal behavior on adolescent depressive symptoms via adolescent rumination, suggesting that rumination might mediate the relationship between low levels of positive maternal behavior and depressive symptoms for girls. This study highlights the importance of positive parenting behaviors as a possible protective factor against the development of adolescent rumination and, subsequently, depressive symptoms. One effective preventive approach to improving adolescent mental health may be providing parents with psychoeducation concerning the importance of pleasant and affirming interactions with their children.

Development and pilot evaluation of an Internet-facilitated cognitive-behavioral intervention for maternal depression.

OBJECTIVE: Develop and pilot an Internet-facilitated cognitive-behavioral treatment intervention for depression, tailored to economically disadvantaged mothers of young children. METHOD: Mothers (N = 70) of children enrolled in Head Start, who reported elevated levels of depressive symptoms, were randomized to either the 8-session, Internet-facilitated intervention (Mom-Net) or delayed intervention/facilitated treatment-as-usual (DI/TAU). Outcomes were measured using the Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996); the Patient Health Questionnaire 9 (PHQ-9; Spitzer et al., 1999), Behavioral Observations of Parent-Child Interactions using the Living in Family Environments coding system (LIFE; Hops, Davis, & Longoria, 1995); the Dyadic Parent-Child Interaction Coding Systems (DPICS; Eyberg, Nelson, Duke, & Boggs, 2005); the Parent Behavior Inventory (PBI; Lovejoy, Weis, O'Hare, & Rubin, 1999); and the Parenting Sense of Competence scale (PSOC; Gibaud-Wallston & Wandersman, 1978). RESULTS: Mom-Net demonstrated high levels of feasibility as indicated by low attrition and high program usage and satisfaction ratings. Participants in the Mom-Net condition demonstrated significantly greater reduction in depression, the primary outcome, at the level of both symptoms and estimates of criteria-based diagnoses over the course of the intervention. They also demonstrated significantly greater improvement on a questionnaire measure of parent satisfaction and efficacy as well as on both questionnaire and observational indices of harsh parenting behavior. CONCLUSIONS: Initial results suggest that the Mom-Net intervention is feasible and efficacious as a remotely delivered intervention for economically disadvantaged mothers.

Emotion socialization within the family environment and adolescent depression.

This review evaluates research addressing the association between parent-child emotional interactions and the development and maintenance of depression in adolescence, with a focus on studies using observational research methods that assess parental responses to children and adolescents' emotional displays. We argue that parental socialization behaviors in response to different emotions expressed by youths may have distinct associations with depressive outcomes. In particular, parental behaviors that reinforce depressive behavior, reciprocate aggression, and fail to positively reinforce positive behavior have each been associated with youth depression. This review identifies a need for more observational research, including prospective, longitudinal studies, to better understand these behaviors, elucidate the directionality of influence between parental socialization behaviors and youth depression, and more clearly identify protective parental socialization behaviors. However, the use of existing findings to inform family-based interventions may improve prevention and treatment efforts directed at youth depression.

Heart rate responses to parental behavior in depressed adolescents.

In order to more fully understand the abnormalities in emotional responding associated with adolescent depression we examined clinically depressed and non-depressed adolescents' physiological responses to their parents' negative emotional behavior, as indexed by their heart rate responses to parental angry and dysphoric behavior during laboratory-based interactions. Maternal angry and dysphoric behavior predicted heart rate deceleration amongst non-depressed adolescents, a response that was not observed in depressed adolescents. Fathers' angry behavior predicted significant heart rate acceleration in depressed (but not non-depressed) adolescents, whereas fathers' dysphoric behavior predicted heart rate deceleration amongst depressed but not amongst non-depressed adolescents. These findings are interpreted within the framework of orienting and defense cardiac responses, and suggest that reactivity in adolescent depression is characterized by the absence of a normative orienting response toward aversive maternal behaviors, and a defensive physiological response to aggressive paternal behavior.