This paper reviews the empirical literature on the association between attention-deficit/hyperactivity disorder (ADHD) and depression (i.e., unipolar depressive disorders and symptoms) among children ...and adolescents. Findings from cross-sectional and longitudinal studies published on the co-occurrence of ADHD and depression were summarized and subjected to a meta-analysis. Results (k=29, N=8755; rbar=0.22) indicated that ADHD and depression were positively related, but substantial variability existed across the studies. Subgroup analyses indicated medium positive effects for cross-sectional studies, studies that operationalized ADHD based on DSM-III or DSM-IV diagnostic criteria, and studies that did not include teacher report in the assessment of ADHD. Subgroup analyses showed a large positive effect for studies that operationalized ADHD based on DSM-III-R criteria and studies using clinic referred samples. In contrast, subgroup analyses indicated a small negative and/or unreliable association between ADHD and depression for longitudinal studies, studies using DSM-II diagnostic criteria for hyperkinetic reaction of childhood or used a dichotomous motor hyperactivity criterion, studies that used nonreferred samples, and studies including teacher report in the assessment of ADHD. When studies that used DSM-II diagnostic criteria were removed, a reliable medium effect was found for studies that included teacher report. Similarly when the study that used idiosyncratic methods of diagnosing ADHD was excluded, a reliable medium effect was found for studies that used nonreferred samples. Potential explanations for the findings are discussed, including explanations based on sampling and base rates, artifacts of diagnostic criteria, inaccurate diagnostic boundaries, and etiological relationships. Directions for future research and clinical implications are discussed.
•ADHD and depression were positively related, but substantial variability existed across the studies.•Few studies have examined potential mediators of the association between ADHD and depression.•Clinicians should routinely screen for depressive symptoms among individuals with a history of ADHD.•Tailored depression preventive efforts for ADHD youth and maintenance treatment of ADHD may reduce the risk of depression.
This research draws upon the interpersonal-psychological theory of suicide in the development of the LEAP intervention, a web-based selective preventive suicide intervention targeting cognitions of ...perceived burdensomeness toward others. The pilot randomized controlled trial consisted of 80 adolescents (68.8% female, 65.8% Hispanic) 13-19 of age years who were randomly assigned to either the LEAP intervention or a psychoeducational control condition. Participants completed baseline, posttreatment, and 6-week follow-up assessments. All participants reported high levels of satisfaction with the program. Findings on outcome variables differed across intent-to-treat analyses and treatment completer analyses. Intent-to-treat analysis yielded no significant between-condition differences in perceived burdensomeness at posttreatment or follow-up. Treatment completer analyses revealed significant between-condition differences on outcome variables such that participants who completed the LEAP intervention showed significantly lower perceived burdensomeness scores at postintervention and significantly lower perceived burdensomeness, thwarted belongingness, and depressive symptom scores at follow-up as compared to participants in the control condition. No significant differences in suicidal ideation were found between conditions. These findings support the promise of the LEAP intervention as a brief, web-based selective preventive intervention for reducing perceived burdensomeness among adolescents who complete the intervention. This study provides evidence that perceived burdensomeness can be modified via a psychosocial intervention. Future research is needed to identify ways to enhance adolescent engagement with and completion of the intervention.
Five versions of the Interpersonal Needs Questionnaire (INQ), a self‐report measure of perceived burdensomeness and thwarted belongingness, have been used in recent studies (including 10‐, 12‐, 15‐, ...18‐, and 25‐items). Findings regarding the associations between perceived burdensomeness, thwarted belongingness, and suicidal ideation using different versions have been mixed, potentially due to differences in measurement scales. This study evaluated factor structure, internal consistency, and concurrent predictive validity of these five versions in three samples. Samples 1 and 2 were comprised of 449 and 218 undergraduates, respectively; Sample 3 included 114 adolescent psychiatric inpatients. All versions demonstrated acceptable internal consistency. The 10‐item version and 15‐item version demonstrated the best, most consistent model fit in confirmatory factor analyses. Both perceived burdensomeness and thwarted belongingness consistently predicted concurrent suicidal ideation on the 10‐item INQ only. Future research should consider using the 15‐item or 10‐item versions.
Purpose
We examined whether the tendency to interpret situation-specific information as indicating one is a liability on others (i.e., burden-related interpretation bias) is associated with beliefs ...that one is a burden on others (perceived burdensomeness) and suicide thoughts and behaviors.
Methods
888 participants completed interpretation bias tasks and measures of perceived burdensomeness, suicide ideation and suicide attempt, and depressive symptoms.
Results
Burden-related interpretation bias was significantly associated with perceived burdensomeness, suicide ideation, and a lifetime suicide attempt. Perceived burdensomeness mediated the associations between burden-related interpretation bias and suicide thoughts and behaviors. These associations largely remained significant after controlling for depressive symptoms.
Conclusions
These results identify burden-related interpretations as an information processing bias related to the belief that one is a burden on others and suicide thoughts and behaviors. As such, they set the stage for the development and evaluation of approaches to intervene on burden-related interpretation bias to prevent and/or reduce suicide thoughts and behaviors.
Context
The interpersonal‐psychological theory of suicide identifies perceived burdensomeness as a primary component of suicidal desire and a possible point of intervention for suicide prevention. A ...growing literature has explored the relationship between perceived burdensomeness and suicide‐related behaviors.
Objective
The aim of this review is to integrate the evidence, identify critical gaps in the evidence‐base, and explore implications for translation to prevention and intervention science.
Methods
Papers published that reported on the association between perceived burdensomeness and suicide‐related behaviors were included.
Results
The literature indicates (a) significant cross‐sectional associations between perceived burdensomeness and suicidal ideation and suicide attempts and (b) that perceived burdensomeness acts as either a moderator or a mediator of the association between risk and protective factors and suicide‐related behaviors.
Conclusion
Research is needed to examine the longitudinal association between perceived burdensomeness and suicide‐related behaviors, develop additional measurement approaches, generalize findings to other samples, and begin translating findings to prevention and intervention science.
The empirical literature on the association between reactive aggression and suicide‐related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met ...inclusion/exclusion criteria is followed by a preliminary meta‐analysis to provide insight into the strength of the association between reactive aggression and suicide‐related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide‐related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta‐analysis indicated a consistent, medium‐sized association (k = 7; N = 4,693; rbar = .25). The narrative review and results of the preliminary meta‐analysis support the promise of pursuing future research on reactive aggression and suicide‐related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.
Objective: The purpose of this study was to examine the effect of maternal depression during the child's first year of life (i.e., sensitive period) on subsequent behavior problems. Method: ...Participants were 175 mothers participating in the Oregon Adolescent Depression Project (OADP) who met lifetime diagnostic criteria for major depressive disorder (MDD) and completed the child behavior checklist (CBCL) for their first child at some point during the child's first 12 years (mean = 4.91 years). Results: Regression analyses indicated that MDD in the sensitive period was a significant predictor of internalizing and total behavior problems on the CBCL while controlling for several demographic variables (e.g., child and mother age, child gender). Maternal depression before pregnancy and during the prenatal period did not significantly predict later child behavior problems, suggesting that the effect was not driven by the presence of previous MDD and was specific to the first year of life. Conclusions: Presence of maternal MDD during a child's first year of life represents a sensitive period and increases the risk of adverse child outcome. The findings suggest the importance of identification, prevention, and early intervention. Future studies should examine these findings in more diverse, heterogeneous samples. (Contains 2 tables.)
Abstract Background Depressive symptoms in college students are prevalent and are associated with considerable academic impairment. Many universities have implemented depressive symptom screening ...programs and the number of students identified as in need of services following screening greatly exceeds available mental health resources. The present study sought to refine depressive symptom screening programs by identifying predictors of a persistent course of depressive symptoms and developing cut-scores for accurately identifying students who will experience a persistent symptom course. Method Students ( n =262) who reported elevated depressive symptoms both an initial screening and baseline assessment ( n =150) were invited to participate in telephone-based follow-up assessments 4, 8, and 12 months post-baseline. Results Two depressive symptom courses were identified: a persistently elevated depressive symptoms course and a decreasing depressive symptoms course. Baseline social disconnection and negative feedback-seeking both significantly predicted membership in the persistently elevated depressive symptoms course. Cut-scores that robustly discriminated between the two symptom courses were identified. Limitations The present sample was predominantly female and Hispanic; the four-month spacing of assessments may have resulted in a failure to identify individuals who experience brief, yet impairing, recurrent depressive episodes. Conclusion These findings can inform approaches to identifying college students most in need of mental health services for depressive symptoms based on the presence of social disconnection and/or negative feedback-seeking. Screening cut-points on social disconnection and negative feedback-seeking measures can reduce the number of cases identified as needing mental health services while retaining the majority of cases who will experience a persistent depressive symptom course.
We report a systematic review and meta-analysis of studies examining the prospective relationship between therapeutic alliance and outcomes for youth ages 6 to 18 receiving intervention for ...internalizing disorders, with a primary aim to identify potential sources of heterogeneity. Twenty studies met criteria for the review and 18 studies met criteria for the meta-analysis. The overall size of the alliance-outcome relationship was small and positive (r = 0.18, p < .01). The strength of the alliance-outcome relationship varied by problem type, alliance timing, and geographic location. Effect sizes were significantly smaller in studies of youth anxiety and significantly larger when alliance was measured between Sessions 4-6 and in studies conducted in the United States. We discuss study implications and methodological considerations for future studies.
Public Health Significance StatementThis systematic review and meta-analysis sheds light on heterogeneity in the relationship between therapeutic alliance and intervention outcomes in youth internalizing disorders (anxiety, depression, and obsessive-compulsive disorder). We found preliminary evidence of heterogeneity with regards to problem type, timing of alliance measurement, and geographic location. This knowledge of "for whom" and "under what circumstances" the alliance contributes most strongly to outcomes can guide efforts to tailor and personalize interventions for youth internalizing disorders by leveraging the therapeutic alliance, thus, enhancing outcomes.
Social media usage and anxiety disorders are highly prevalent among emerging adults aged 18-28 years. Emerging adults frequently use social media to learn and communicate about anxiety; however, we ...are not aware of studies that have examined whether social media, as an information source, is associated with accurate anxiety knowledge or use of adaptive coping strategies. In a sample of 250 participants, we evaluated where emerging adults seek anxiety information and the associations between source, anxiety knowledge, and coping strategies. Participants rated the internet (e.g., Wikipedia, medical websites) as their most used anxiety information source, followed by friends and family, therapy, and social media. Social media, as an information source, was associated with lower anxiety knowledge, and this effect was moderated by types of accounts followed (e.g., mental health professionals, nonprofessionals, and health organizations). Most participants reported using coping strategies suggested on social media, and social media as a source was positively associated with the use of both adaptive and maladaptive coping strategies. While social media provides immediate, accessible, and plentiful information, seeking this information on social media may not result in accurate knowledge about anxiety.
Public Policy Relevance Statement
Our findings highlight important nuances in the associations between social media usage and anxiety symptoms. Although anxiety information seeking on social media is common among emerging adults, more frequent information seeking is associated with lower knowledge about anxiety and indiscriminate use of coping strategies, both adaptive and maladaptive. Our findings indicate a need to promote dissemination of accurate information about anxiety on social media and aid emerging adults in discriminating between adaptive and maladaptive coping strategies.
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