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Objective To identify symptom dimensions of depression that predict recovery among SSRI-treatment resistant adolescents undergoing second-step treatment. Method The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI-treatment resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale-Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. Results Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that Anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when Anhedonia and CDRS-total score were evaluated simultaneously, Anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. Conclusions Anhedonia may represent an important negative prognostic indicator among treatment resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression.

This article examined the effects of maternal depression during the postpartum period (Time 1) on the later behavior problems of toddlers (Time 3) and tested if this relationship was moderated by paternal psychopathology during toddlers’ lives and/or or mediated by maternal parenting behavior observed during mother–child interaction (Time 2). Of the 101 mothers who participated in this longitudinal study with their toddlers, 51 had never experienced an episode of Major Depressive Disorder (MDD) and 50 had experienced an episode of MDD during the first 18 months of their toddlers’ lives. Maternal depression at Time 1 was significantly associated with toddlers’ externalizing and internalizing behavior problems only when paternal psychopathology was present. As predicted, maternal negativity at Time 2 was found to mediate the relationship between maternal depression at Time 1 and toddlers’ externalizing behavior problems at Time 3.

Objective-To compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls.Method-Currently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting.Results-Depressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children.Conclusions-Mother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.Keywords major depressive disorder; high risk; mother-child interaction; parenting Family interactions provide a rich context for studying the bidirectional relationship between interpersonal environments and the onset and course of psychopathology in depressed children and adolescents. Depressed children and adolescents have discordant family relationships, marked by high rates of conflict, hostility, rejection, low support and cohesion, Copyright © 2008 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript and poor communication, [1][2][3][4][5] that may persist after children and adolescents recover from acute depressive episodes. 6,7 As such, maladaptive family interactions have been postulated to be one of the mechanisms by which depression develops and is maintained in at-risk children and adolescents. 4,8 Research on children of depressed mothers further indicates that poor family functioning, negative mother-child interactions and maladaptive parenting strategies may predate the development of depression in children with familial loading for depression. 9,10 Because of the bidirectional nature of child and parent factors that contribute overall discordant interactions in families of depressed children, it remains unclear whether negative family interactions precede depression in children and adolescents or whether negative family interactions are a consequence of children's depressive symptoms 1,11-13 or both. Two recently published studies sought to untangle ...

Two months following perinatal loss, 82 mothers out of a total of 205 whose infants died at a tertiary referral obstetrical hospital and 47 of their partners were assessed with regard to their reactions to the deaths of their infants. Sample to population comparisons indicated that those who participated in the investigation were more likely to be socially advantaged. Intensity of mothers' grief exceeded fathers', but in roughly 25% of cases fathers' grief exceeded mothers. Mothers with higher self‐reports of ego strength reported lower intensity of grief. Fathers with less ego strength, less social support, and more stressful life events had significantly higher self‐reported grief. A subgroup of parents who reported minimal grief was identified and characterized. Implitions of these findings for research on reactions to perinatal loss are discussed.

This study examined Expressed Emotion in the families of children and adolescents who were: (1) in a current episode of Major Depressive Disorder (MDD), (2) in remission from a past episode of MDD, (3) at high familial risk for developing MDD, and (4) low-risk controls. Participants were 109 mother-child dyads (children ages 8-19). Expressed emotion was assessed using the Five Minute Speech Sample. Psychiatric follow-ups were conducted annually following the Five Minute Speech Sample assessment. Mothers of children with a current or remitted episode of MDD and at high risk for MDD were more likely to be rated high on Criticism than mothers of controls. There were no differences in critical expressed emotion among mothers of children in the current, remitted, or highrisk for depression groups. Higher initial critical expressed emotion was associated with a greater likelihood of having a future onset of a depressive episode in high-risk and depressed participants. Diagnostic groups did not differ in Emotional Overinvolvement. Findings suggest that expressed emotion that is critical in nature may be a relatively stable characteristic feature of the family environments of children with and at high-risk for depression, and may be important in understanding the onset and clinical course of child adolescent depressive disorders.Depression during childhood and adolescence is a frequent and recurrent problem that is associated with disruptions in emotional, social and occupational functioning into adulthood and increased rates of attempted and completed suicides (Bardone, Moffitt, Caspi, & Dickson, 1996;Rohde, Lewinsohn, & Seeley, 1994;Weissman et al., 1999). Most adolescents with depression will go on to have recurrent episodes and persistent social impairment between episodes (Puig- Antich et al., 1985b;Weissman et al., 1999). In order to improve upon existing prevention and intervention programs, a better understanding of the contextual factors that contribute to the onset, maintenance, and recurrence of depressive episodes in children and adolescents is crucial.The development and maintenance of depressive disorders in childhood and adolescence involves the interplay among inherited and acquired biological characteristics and the individual's social environment (Cicchetti & Toth, 1998). In particular, features of the family environment appear to play an important role in child adolescent depression (for reviews see Kaslow, Deering, & Racusin, 1994;Sheeber, Hyman, & Davis, 2001). Interpersonal theories of depression emphasize high levels of rejection in the environments of depressed individuals (Coyne, 1976). Consistent with interpersonal theories, a growing body of literature suggests Please address correspondence to Jennifer S. Silk, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. Phone: 412-383-8136. Fax: 412-383-5426. Email: silkj@upmc.edu. that the families of children and adolescents with depressive disorders are characterized by low levels o...

Objective Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children’s psychosocial functioning, LOC-eating, and body mass. Method A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n=15) or FB-HE (n=14) and evaluated at post-treatment, six-months, and one-year. Changes in child psychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. Results FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI −7.23, −2.01, Cohen’s d=1.23) and anxiety (95% CI −6.08, −0.70, Cohen’s d=.79) and less odds of LOC-eating (95% CI −3.93, −0.03, Cohen’s d=.38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI −0.72, −0.05, Cohen’s d=.66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI −8.82, 0.44, Cohen’s d=.69) than FB-HE. There was no difference in BMI gain between the groups. Discussion Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.

Purpose-To examine the association between depressive symptoms and subclinical markers of cardiovascular disease (CVD), specifically arterial stiffness, as indexed by pulse wave velocity (PWV), and carotid artery intima thickening (IMT), in a sample of healthy adolescents, and to explore adolescent hostility as a potential moderator of depression on subclinical markers of CVD.Methods-One hundred and fifty-seven (n = 157) black and white adolescents between the ages of 16-21 completed a follow-up study of psychosocial stress and cardiovascular risk factors that included measures of PWV and carotid IMT. Psychosocial measures included the Center for Epidemiologic Studies Depression Scale (CES-D; divided into tertiles), and the Cook-Medley Hostility Inventory subscales. Linear regression models controlled for sociodemographic variables, health behaviors, blood pressure, body mass index, and heart rate. Results-Resultsshow that more severe depressive symptoms were associated with higher levels of PWV (B = 0.17, R 2 = 0.30, ΔR 2 = 0.03, CI = 2.2 -47.0, p = .03) but not with higher IMT. Adolescent depression remained a significant predictor of PWV when controlling for adolescent hostility; hostility did not moderate the relationship between adolescent depression and PWV.Conclusions-Depression may be important in the development of arterial stiffness in adolescence. Further research is needed to delineate the relationship in adolescence and young adulthood between depressive symptoms and the pathogenesis of CVD. Keywords depression; adolescents; hostility; pulse wave velocity; cardiovascular disease Depression is a debilitating and burdensome mental health condition, due to its high prevalence, chronic nature, and associated physical health conditions that contribute to lost productivity and high costs of medical care 1-2 . The relationship between depression and chronic health conditions, such as heart disease, asthma, diabetes, and arthritis, has been highlighted for its public health significance, as depression often develops earlier in the lifespan than do most progressive health conditions 3 . While the association between depression and chronic physical illness has been firmly documented in the empirical literature, the mechanisms accounting for the association remain unclear 4 . Physiological mechanisms, shared etiological factors, and poor health behaviors have been proposed to account for this relationship 5 .Correspondence should be sent to Dr. Dietz, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Bellefield Towers Room 309, Pittsburgh, PA 15213; dietzlj@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the ...