Similarities and Differences in the Architecture of Cognitive Vulnerability to Depressive Symptoms in Black and White American Adolescents: A Network Analysis Study.

The hopelessness theory, Beck's cognitive theory, and the response styles theory dominate our understanding and the treatment of depression in adolescents. However, research supporting them is largely based on White individuals. Further, the associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black adolescents are not as one would expect based on the predictions from those theories. Both raise the question of if and to what degree these theories and previous findings can be generalized to Black adolescents. Additionally, without a theoretical basis, clinicians regularly use interventions developed based on one theory to influence vulnerabilities described in another theory. Thus, the purpose of our study was to examine the structure of an integrated cognitive stress-vulnerability model as well as the strengths of associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black and White adolescents. In our study, 295 Black (37% female) and 213 White (49% female) ninth-grade students from a public high school participated. Network analyses demonstrated that the three original cognitive theories of depression can and should be integrated and that each variable we examined is comparably relevant for Black and White adolescents. At the same time, the structure of the two integrated networks differed significantly among Black and White adolescents, exhibiting specific distinctions at four edge levels. Furthermore, the predictability of the network is notably lower for Black adolescents than for White adolescents. Important theoretical and clinical implications can be derived.

Discrimination, cognitive styles, and their associations with adolescents' mental and physical health.

This study is based on the hopelessness theory of depression and previous research on perceived everyday discrimination (PED) and both depressive symptoms and Interleukin-6 (an inflammatory cytokine; IL-6) in adolescents. The purpose of this study is to examine the negative attribution, self, and consequence cognitive styles (CSs) proposed in the hopelessness theory as a possible mechanism underlying the association between PED and inflammation in adolescents and expand our understanding of the comorbidities between depressive symptoms and systemic inflammation (IL-6). This cross-sectional study featured a sample of 102 adolescents aged 13-16 (M = 14.10, SD = 0.52) who identified as White (47.5%), Black (41.4%), Mixed Race (7.1%), Latino (2%), and other (2%). Data analysis was conducted using PROCESS to compute regressions and effects between PED, negative CSs, depressive symptoms, and Interleukin-6. Results showed that negative attribution CS is the only negative CS associated with PED, depressive symptoms, and IL-6. Negative attribution CS is also the only negative CS of the three negative CSs that mediates both the association between PED and depressive symptoms and PED and IL-6 in our adolescent sample. Overall, these results indicate that individual negative CSs proposed in the hopelessness theory impact adolescents' physical and mental outcomes differently, which can inform targeted treatments. Nurses should provide cognitive-based interventions and promote societal-level change to reduce the experience and impact of PED on the mental and physical health of their adolescent patients.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial.

BACKGROUND: With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE: This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS: In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS: A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS: Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.

Role of Dysfunctional Attitudes in the Association Between Discrimination and Adolescents' Mental and Physical Health.

Our study is based on Beck's cognitive stress-vulnerability theory of depression and research on (a) disparities in elevated blood pressure between adolescents from minority and majority backgrounds, (b) the effects of perceived everyday discrimination (PED) on depression and elevated blood pressure, and (c) the associations between depression and cardiovascular diseases. The purpose of our study is to integrate Beck's model and the different research lines by examining the associations of the stressor PED and depressive symptoms with blood pressure through the cognitive vulnerability of dysfunctional attitudes in adolescents. In our cross-sectional study, 97 adolescents (40% female) aged 13 to 15 (M = 14.15, SD = .53) who identified as Black (47.5%), white (47.5%), and mixed race (5%) completed self-reports of PED, dysfunctional attitudes, and depressive symptoms and had their blood pressure measured. We used the PROCESS command tool for SPSS to compute OLS regressions and direct, indirect, and total effects of PED, dysfunctional attitudes, and depressive symptoms on blood pressure. As predicted, our analyses revealed that PED predicts dysfunctional attitudes and depressive symptoms, dysfunctional attitudes predict marginally significant depressive symptoms and significantly systolic blood pressure. Our findings highlight the relevance of PED and dysfunctional attitudes for adolescents mental (i.e., depressive symptoms) and physical health (i.e., blood pressure). If this pattern is replicated, systemic interventions to reduce PED and individual interventions to address dysfunctional attitudes in adolescents could be promising to improve both mental (i.e., depressive symptoms) and physical health (i.e., BP).

Relation Between the Negative Cognitive Triad, Perceived Everyday Discrimination, Depressive Symptoms, and TNF-⍺ in Adolescents.

Our study is guided by Beck's cognitive stress-vulnerability model of depression. We examined the associations between perceived everyday discrimination (PED) and TNF-⍺, an inflammatory biomarker associated with risk for severe illness, through the negative cognitive triad (NCT; negative thoughts about the self, world, and future) and depressive symptoms in adolescents. We utilized a sample of 99 adolescents (36.4% female; ages 13-16, M = 14.10, SD = 0.52) in our cross-sectional study. We used PROCESS and AMOS to compute regressions and direct, indirect, and total effects of PED, NCT aspects and depressive symptoms on TNF-⍺. Negative views of the self and world mediated between PED and depressive symptoms and that negative views of the self and future mediated between PED and TNF-⍺. In conclusion, Beck's theory can be expanded to physical health providing directions for addressing mental and physical health simultaneously by restructuring adolescents' negative view of the self.

Temporal Directionality Between Teaching Behavior and Affect in High School Students.

The associations between teaching behaviors and students' affect are examined in cross-sectional studies in younger samples, but the temporal direction of these associations in high school students is unknown. In this longitudinal study, adolescents (N = 188; 88.8% White; 69.7% female) completed instruments to measure teaching behaviors and adolescents' negative (e.g., cheerful) and positive affect (e.g., ashamed) twice, four months apart. Adolescents' negative affect predicted future negative teaching behavior and negative teaching behavior marginally predicted adolescents' future negative affect. Positive affect predicted future socio-emotional teaching behavior and vice versa. The findings provide insight into which teaching behaviors impact students' affect and the impact that students' mental health has on teaching behavior, an area of study that has received limited attention.

Comprehensive Prevention: An Evaluation of Peripheral Outcomes of a School-based Prevention Program.

By age 18, 22-27% of adolescents have experienced depressive symptoms increasing their risk of peripheral mental health and social issues. Despite the development of effective depression prevention programs, issues related to dissemination persist. This study aims to identify ways of increasing the likelihood of dissemination by a) investigating how prevention effects differ based on the professional background of the prevention program group leader and b) evaluating adolescent depression prevention in terms of comprehensive prevention - prevention with the breadth to reduce peripheral mental health and social issues. This cluster-randomized trial included 646 eighth-grade students recruited from German secondary schools. Adolescents were randomized into three conditions: teacher-led prevention, psychologist-led prevention, or school-as-usual. Results from hierarchical linear models reveal differences in effects based on implementation type and adolescent gender and provide preliminary evidence for a wider reach of depression prevention such that, regardless of implementation type or gender, the tested program was effective in reducing hyperactivity over time. Taken together, our findings warrant further research and suggest that depression prevention programs may have an effect on some peripheral outcomes, but not others, and that these effects may differ based on the profession of the group leader and adolescent gender. With continued empirical research investigating the efficaciousness of comprehensive prevention, this type of prevention has the potential to impact a larger proportion of the population and improve the cost-benefit ratio of prevention, thus increasing the likelihood of dissemination.

Relations of cognitive styles, depressive symptoms, and blood pressure in community college students.

OBJECTIVE: We proposed cognitive styles described in the Hopelessness Theory would be associated with depressive symptoms and Systolic Blood Pressure (SBP) and that depressive symptoms mediate these associations. PARTICIPANTS: This cross-sectional study had 324 community college student participants (ages: 18 to 62 years, M = 24.08, SD = 9.10; 57.3% female; 57.3% White, 29.8% Black, 8.8% Latinx, 8.8% Other). METHODS: Besides self-reports of cognitive styles and depressive symptoms, resting blood pressure was measured three times at 1-min intervals and the mean was used in the analysis. RESULTS: Path analyses demonstrated differing associations between each cognitive style and SBP and no mediation, suggesting cognitive styles and depressive symptoms are independently associated with SBP. CONCLUSIONS: When conceptualizing and measuring the associations of cognitive styles with depressive symptoms and SBP, the styles should be evaluated individually. Interventions targeting cognitive styles might be especially beneficial as changing them might improve mental and physical health.

Cognitive Triad and Depressive Symptoms in Adolescence: Specificity and Overlap.

Adolescence is a critical period for the development of depressive symptoms and the understanding of vulnerability factors that facilitate their onset is pivotal. In this study, we focused on Beck's cognitive triad, namely its three-fold structure, comprising views of the self, world, and future. Despite its crucial role in the cognitive theory of depression, the relationship between the cognitive triad and depressive symptoms in adolescence is still unclear. In our study, we adopted a meta-analytic commonality analysis approach, in order to clarify whether the three components of the triad overlap in accounting for depressive symptoms, or they show distinct profiles of association. By relying on six independent samples of early adolescents (age range = 13-14: n = 174, 66% female, n = 347, 41% female), mid adolescents (age range = 15-17: n = 304, 61% female; n = 92, 34% female), and late adolescents (age range = 18-21: n = 217, 84% female, n = 101, 56% female), we showed that the views of the self, world, and future substantially overlap in accounting for depressive symptoms, although specific areas of distinctiveness could be detected. Moreover, the association between the cognitive triad and depressive symptoms appeared to be a function of both the developmental phase and gender. Furthermore, the cognitive triad emerged as specifically related to symptoms related to negative mood, absence of positive mood, and negative appraisal of the past. These findings advance our understanding of cognitive vulnerability for depressive symptoms in adolescence.

Perceived discrimination and depressive symptoms: What role does the cognitive triad play?

OBJECTIVE: The present study was designed to integrate perceived everyday discrimination (PED) as stressor in Beck's cognitive theory of depression. We focused on the relationships between PED, the individual components of the cognitive triad, and depressive symptoms and the role of gender and race in these relationships. METHOD: Participants included 243 technical and community college students (women: 59%; men: 41%; Black: 30%; White: 51%). They completed measures examined PED, the cognitive triad, and depressive symptoms. RESULTS: Conducting mediation analyses using PROCESS 4.1.1, we found significant indirect effects from PED on depressive symptoms through negative views of the self and world. The indirect effect through negative views of the future was not significant. The indirect effects of negative views of the world and future were significantly stronger in women participants than men participants and the indirect effect of negative views of the world was significantly stronger in White students than Black students. CONCLUSIONS: Our findings generally support the integration of PED as stressor into Beck's cognitive theory independent of gender and race. This highlights the responsibility of therapists to assist clients in coping with PED and to advocate for equality within organizations, communities, and society in general.

PATH 2 Purpose: Design of a comparative effectiveness study of prevention programs for adolescents at-risk for depression in the primary care setting.

The majority of mental, emotional, and behavioral (MEB) disorders have an initial onset before age 24, with 20% annual incidence, and with major depressive disorder (MDD) being the most common MEB. Health systems may be able to reduce costs by transitioning from the current treatment-focused model for MDD to a prevention model. However, evidence is needed for (1) the comparative effectiveness of a "scalable intervention" and (2) an implementation model for such a scalable intervention in the primary care setting. This paper describes a comparative effectiveness trial evaluating the efficacy of two evidence-based cognitive-behavioral prevention (CBP) programs: Teens Achieving Mastery over Stress (TEAMS), the "gold standard," group therapy model, and Competent Adulthood Transition with Cognitive Behavioral, Humanistic and Interpersonal Training (CATCH-IT), a scalable, self-directed, technology-based model. Eligible adolescents, age 13-19, are offered one of these two depression prevention programs across five health systems (30 clinics) in urban and suburban Chicago, IL, rural Western IL, and Louisville, KY. We are comprehensively evaluating patient-centered outcomes and stakeholder-valued moderators of effect versus baseline at two, six, 12, and 18-month assessment points. Using a hybrid clinical trial design that simultaneously examines the implementation process, the study is also assessing adolescents', parents', and providers' experiences (e.g., efficacy, time commitment, cultural acceptability) within each intervention approach.

Association of cancer caregiver stress and negative attribution style with depressive symptoms and cortisol: a cross-sectional study.

PURPOSE: We examined the effect of informal cancer caregiver stress and negative attribution style (NAS) on depressive symptoms and salivary cortisol. METHOD: The sample came from a hospital bone marrow unit and caregiver support organizations and included 60 informal cancer caregivers (51.7% partners) of individuals with cancer (provided care for a median of 27.5 h per week for 12 months) and 46 non-caregiver participants. In this cross-sectional study, participants completed questionnaires assessing NAS and depressive symptoms and provided saliva samples to measure cortisol. RESULTS: Linear regressions demonstrated that cancer caregiver stress (p = 0.001) and the cancer caregiver stress by NAS interaction (p = 0.017), but not NAS alone (p = 0.152), predicted depressive symptoms. Caregivers independent of their NAS and non-caregivers high in NAS reported high depression while non-caregivers low in NAS reported low depression. Neither cancer caregiver stress (p = 0.920) nor NAS alone (p = 0.114), but their interaction, predicted cortisol (p = 0.036). Higher NAS was associated with a higher cortisol in both groups while non-caregivers had higher cortisol than caregivers. CONCLUSIONS: If the findings can be replicated, consideration of NAS in existing interventions to support informal cancer caregivers in managing chronic stress appears warranted.

Exploring the Relation between Adolescents' Number of Perceived Reasons for Discrimination and Depressive Symptoms.

Methodological impediments have presented challenges in identifying which individuals are at the highest risk of experiencing discrimination and its detrimental corollaries. In the current study, we examined whether adolescents' number of perceived reasons for everyday discriminations (i.e., number of identities and/or characteristics adolescents identify as the reasons(s) they are discriminated against) is associated with frequency of perceived everyday discriminations (PED) and depressive symptoms. Further, we evaluated indirect associations between number of perceived reasons for PEDs and depressive symptoms through frequency of PED, brooding, and reflection. The sample for this cross-sectional study consisted of 328 9th grade students between the ages of 13 and 16 (M = 14.19, SD = 0.56). Around 60% of the sample identified as male, and a majority of the adolescents identified their race as either Black (46%) or White (35%). Adolescents provided data on perceived reasons for PEDs, frequency of PED, brooding, reflection, and depressive symptoms using self-report measures. Adolescents' number of perceived reasons for PEDs was associated with frequency of PED and depressive symptoms. There were also multiple indirect associations between adolescents' number of perceived reasons for PEDs and depressive symptoms through frequency of PED, brooding, and reflection. Our results indicate that accounting for adolescents' number of perceived reasons for PEDs may be useful to both researchers and clinicians in identifying which individuals are at the greatest risk of experiencing PED and associated outcomes. Additional implications and future directions for research are discussed.

Are negative views of the self, world and future, mediators of the relationship between subjective social status and depressive symptoms?

BACKGROUND: Elevated depressive symptoms are associated with impairments, reduced quality of life, and societal economic burden. A well-established stress-vulnerability model explaining depressive symptoms is Beck's cognitive theory (Beck, 1976). An independent line of research demonstrated that a person's perception of their status in comparison with others' (subjective social status, SSS) is a stressor associated with depressive symptoms. AIMS: Theory-driven research investigating the interplay of different factors associated with depressive symptoms opens the door to improve the lives of the affected individuals and to reduce the overall societal burden. This study's aim was to examine if SSS can be integrated as a stressor into Beck's theory, looking specifically at whether it impacts depressive symptoms through the individual components (self, world and future) of the cognitive triad. METHOD: In this cross-sectional study, 243 community college students (58.6% female; mean age 23.95 years) in the southern United States completed self-reports measuring SSS, negative views of the self, world and future, and depressive symptoms. RESULTS: SSS is negatively associated with each view of the cognitive triad. SSS and views of the self and world are negatively associated with depressive symptoms. Mediation analyses displayed a significant direct effect between SSS and depressive symptoms, as well as two indirect effects via negative view of self and world. CONCLUSIONS: While further research is needed, therapists might benefit from our findings when tailoring their treatment to a client by considering their SSS and which negative view is particularly detrimental for this specific client.

Depressive Symptoms Among Adolescents: Testing Vulnerability-Stress and Protective Models in the Context of COVID-19.

Adolescents who experience negative life events may be at risk for depression, particularly those with psychosocial vulnerabilities. We investigate longitudinally the impact of vulnerability/protective factors on the relation between a large-scale negative life event, the COVID-19 pandemic, and depressive symptoms. Adolescents (N = 228, Mage = 14.5 years, 53% female, 73% white) self-reported depressive symptoms 2-4 months before the pandemic (Time 1), and again 2 months following stay-at-home orders (Time 2). At T2, adolescents also completed measures of vulnerability, protective factors, and COVID-19-related distress. Depressive symptoms increased at T2, and COVID-19 distress interacted with resilience and negative cognitive style in predicting increases in T2 depression. Focusing on vulnerability and protective factors in adolescents distressed by large scale negative life events appears crucial.

A Primer on Meta-Analytic Structural Equation Modeling: the Case of Depression.

In this paper, we show how the methods of systematic reviewing and meta-analysis can be used in conjunction with structural equation modeling to summarize the results of studies in a way that will facilitate the theory development and testing needed to advance prevention science. We begin with a high-level overview of the considerations that researchers need to address when using meta-analytic structural equation modeling (MASEM) and then discuss a research project that brings together theoretically important cognitive constructs related to depression to (a) show how these constructs are related, (b) test the direct and indirect effects of dysfunctional attitudes on depression, and (c) test the effects of study-level moderating variables. Our results suggest that the indirect effect of dysfunctional attitudes (via negative automatic thinking) on depression is two and a half times larger than the direct effect of dysfunctional attitudes on depression. Of the three study-level moderators tested, only sample recruitment method (clinical vs general vs mixed) yielded different patterns of results. The primary difference observed was that the dysfunctional attitudes → automatic thoughts path was less strong for clinical samples than it was for general and mixed samples. These results illustrate how MASEM can be used to compare theoretically derived models and predictions resulting in a richer understanding of both the empirical results and the theories underlying them.

The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study.

Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck's cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.

The Conceptualization of the Positive Cognitive Triad and Associations with Depressive Symptoms in Adolescents.

The positive cognitive triad (positive cognitions about the self, world, and future) has been considered a protective factor against depressive symptoms. This study examines three conceptualizations of the positive cognitive triad and their relation to depressive symptoms. Analyses were replicated in two samples in order to provide evidence for the validity of findings. Two samples (n1 = 2982, Mage = 13.04, Rangeage = 11-15 years; n2 = 2540, Mage = 13.11, Rangeage = 11-16 years) of Australian adolescents completed the Positive Cognitive Triad Inventory and Center for Epidemiological Studies Depression Scale. Findings supported the notion that the overall positive cognitive triad is a protective factor for depressive symptoms, and specifically, the role of positive cognitions about the self in this protection. After future studies examine the directionality of the relation between positive cognitions and depressive symptoms, mental health providers using cognitive behavioral approaches may consider examining positive cognitions with patients.

Does frontal brain activity mediate the effect of depression prevention in adolescents? A pilot study.

We investigated whether (a) depression prevention was associated with depressive symptoms and medial-frontal alpha asymmetry in adolescents; (b) alpha asymmetry mediated the association between participation in a prevention program and depressive symptoms; and (c) gender affects these associations. In our randomised control group study, we compared a universal prevention program (n = 40 adolescents, 14 females) with a non-intervention control condition (n = 39 adolescents, 20 females) in German secondary school students (mean age: 13.53 years, SD = 0.53). We collected data at baseline, post-intervention, 6-month, and 12-month follow-up using the Self-Rating Questionnaire for Depressive Disorders (SBB-DES) and resting medial-frontal alpha activity on F3 and F4. We found that girls benefitted from participating in the prevention program in regards to their depressive symptoms at 12-month follow-up but not alpha asymmetry. In boys, participation in the prevention program was associated with their alpha asymmetry at 6-month follow-up but not their depressive symptoms. Alpha asymmetry did not mediate the effects of the prevention program on depressive symptoms in either gender. Although participation in the prevention program was associated with both depressive symptoms and alpha asymmetry, those associations seem independent from each other. Possible explanations for this result pattern are discussed.

Integrating Beck's Cognitive Theory of Depression and the Hopelessness Model in an Adolescent Sample.

Adolescence is a critical period in the development of depression. Hence, researching the applicability of cognitive theories in adolescents is crucial. Currently, much remains unknown about how cognitive variables proposed in different theories interplay with one another and whether gender differences in these associations exist. Attempting to integrate Beck's cognitive model and the hopelessness model in adolescents, we conducted a 4-wave study using self-report instruments with 499 adolescents (mean ageTime1 = 15.33 years; SD = 0.75; 63.3% female; 73.7% White, 13.8% Black, 5.4% Latina/o, 4.4% mixed race/ethnicity, and 2.6% other) from a high school where almost one third of the students were eligible for free or reduced lunch. Using AMOS and PROCESS to calculate and compare four different theory-driven models, we found support for an integrated model in which the inferential styles proposed in the hopelessness model are located between cognitive errors and the cognitive triad from Beck's cognitive theory. Further, the individual inferential styles and elements of the cognitive triad are associated differently with each other and other variables in the integrated cognitive model. The gender differences we found were limited and did not form a meaningful pattern. If replicated, the integrated model could be the basis to understand how therapeutic techniques developed to modify cognitive variables proposed in one model can impact cognitive constructs from a different theory. This might make cognitive psychotherapies for depression more effective, as it will allow clinicians to integrate therapeutic techniques based on either of the original theories in one theory-driven treatment approach.