Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n=5908) were included in a random effects metaanalysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was-0.45 (95% CI:-0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d=-0.81, 95% CI:-1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.

Background: Adolescence is a period of increased risk for the development of depression. Epidemiological and clinical studies suggest that the phenomenology of depression may differ during childhood and adolescence. However, participants in these studies may not reflect depressed young people referred to routine clinical services. The aim of this paper was to describe referrals for depression to a UK routine public healthcare service for children and adolescents with mental health difficulties. Method: This paper describes a consecutive series of adolescents (N = 100, aged 12-17 years), referred for depression to a routine public healthcare child and adolescent mental health service, in the south of England. Young people and their caregivers completed a structured diagnostic interview and self-report measures of anxiety and depression. Results: Fewer than half of young people referred for depression met diagnostic criteria for a depressive disorder. The key symptoms reported by those with depression were low mood or irritability, cognitive disturbances, sleep disturbances and negative self-perceptions. Suicidal ideation was common and was considerably higher than reported in other studies. Caregiver and young person's accounts of adolescent symptoms of depression and anxiety were uncorrelated. Caregivers also reported fewer symptoms of depression in their child than adolescents themselves. Conclusions: These data have direct relevance to the design and delivery of public mental health services for children and adolescents. However, we do not know how representative this sample is of other clinical populations in the UK or in other countries. There is a need to collect routine data from other services to assess the needs of this group of high-risk adolescents. Key Practitioner Message• Existing data suggest that the characteristics and symptoms of depression in children and adolescents may differ from those reported by depressed adults.• These data may not generalize to adolescents who are referred to and assessed by the UK National Health Service for the treatment of depression.• Of 100 adolescents referred for depression to a routine public child and adolescent mental healthcare service in the United Kingdom, fewer than half met diagnostic criteria for a depressive disorder.• The most common symptoms of the depressed group were low mood or irritability, suicidal ideation, cognitive disturbances, sleep disturbances and negative self-perceptions.• Suicidal ideation was much higher in all groups than reported in clinical trials. • There are currently no guidelines in place regarding (a) how to treat adolescents who do not meet diagnostic criteria for any disorder, but are experiencing distress, impairment and often risk, and (b) how to support and manage clinical staff who are dealing with such high levels of risk.

Background: Sleep problems are common in adolescence, and frequently comorbid with both anxiety and depression. Research studies have suggested a bidirectional relationship between sleep and psychopathology, which includes evidence that sleep interventions can alleviate symptoms of anxiety and depression. However, little is known about the nature of sleep problems amongst adolescents with anxiety and depression, and whether specific sleeping difficulties are involved in the longitudinal relationship between sleep, anxiety and depression. Method: The sample was derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective, birth cohort study of children born in 1991-1992. Data were explored from a subset of participants who took part in a clinical assessment at age 15, on self-report sleep patterns and quality, and diagnostic outcomes of anxiety and depression (N = 5,033). Subsequent diagnostic and symptom severity data on anxiety and depression at ages 17, 21 and 24 were also examined. Results: Cross-sectional and longitudinal analyses were conducted to explore the relationship between sleep problems, anxiety and depression. Results revealed that adolescents aged 15 with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only reported problems with sleep quality. A range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and the diagnoses of anxiety and depressive disorders at age 17, 21 and 24 years. Conclusions: The results provide further insight into the nature of sleep problems amongst adolescents with anxiety and depression, and the prospective relationship between sleep disturbance and future psychopathology. These data suggest that targeting sleep difficulties during adolescence may have long-term mental health benefits.

ObjectivesDepression is characterized by a range of systematic negative biases in thinking and information processing. These biases are believed to play a causal role in the aetiology and maintenance of depression, and it has been proposed that the combined effect of cognitive biases may have greater impact on depression than individual biases alone. Yet little is known about how these biases interact during adolescence when onset is most common.MethodsIn this study, adolescents were recruited from the community (n = 212) and from a Child And Adolescent Mental Health Service (n = 84). Participants completed measures of depressive symptoms, interpretation bias, self‐evaluation, and recall memory. These included the Mood and Feelings Questionnaire, Ambiguous Scenarios Test for Depression in Adolescents, Self‐Description Questionnaire, and an immediate recall task. The clinically referred sample also took part in a formal diagnostic interview.ResultsIndividual cognitive biases were significantly intercorrelated and associated with depression severity. The combination of cognitive biases was a stronger predictor of depression severity than individual biases alone, predicting 60% of the variance in depression severity across all participants. There were two significant predictors, interpretation bias and negative self‐evaluation; however, almost all of the variance was explained by negative self‐evaluation.ConclusionsThe findings support the interrelationship and additive effect of biases in explaining depression and suggest that understanding the way in which cognitive biases interact could be important in advancing methods of identification, early intervention, and treatment.Practitioner points A combination of biases was a better predictor of depression symptom severity than individual biases.Interpretation and self‐evaluation were better predictors of depression symptom severity than recall.Negative self‐evaluation was the strongest individual predictor of depression symptom severity.Negative self‐evaluation was able to classify depressed from non‐depressed adolescents.The cross‐sectional design of the study precludes any conclusions about the potential causal role of these variables.Different tasks were used to assess different types of cognitive bias meaning that the possible linear operation along an information processing ‘pathway’ could not be examined.

Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11–17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents’ parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents’ dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.