Comorbidity of anxiety and depression in youth: Treatment implications.

Reviews the empirical literature on the comorbidity of anxiety and depressive disorders in youth, emphasizing prevalence of comorbidity, difficulties in assessment and measurement, familial factors, and developmental differences. The nature of anxiety and of depression in youth is examined (e.g., differentiating cognitive deficiencies from cognitive distortions), and treatment recommendations are presented from a cognitive-behavioral framework. Components of the treatment include affective education, enactive programming, addressing reinforcement difficulties, correcting cognitive distortions, and enhancing problem-solving skills. Peer and familial factors are discussed. Successful treatment of comorbid children relies on a flexible application of these strategies with consideration of the developmental level and particular symptom constellation of the individual child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety

Research conducted with adult samples suggests that anxiety sensitivity is positively related to depression (Otto et al., 1995, Journal of Anxiety Disorders, 10, 117-123). The Childhood Anxiety Sensitivity Index (CASI, Silverman et al., 1991, Journal of Clinical Child Psychology, 20 162-168) was used in this study to provide an examination of the relation between anxiety, anxiety sensitivity, and depression in a sample of children and adolescents (N = 234) referred for anxiety disorders. A significant correlation between depression and anxiety sensitivity was found. This relation remained statistically significant when controlling for other aspects of anxiety (i.e. worry, physiological anxiety, and concentration). The similarities between these findings and findings obtained with adults are discussed, as well as suggestions for future research.     

Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults.

The current and lifetime comorbidity of depressive (i.e., major depressive disorder and dysthymia) with other common mental disorders was examined in community samples of older adolescents (n?=?1,710) and adults (n?=?2,060). Current and lifetime histories of depression in the adolescents were highly comorbid with several other mental disorders. The adults had a lower but statistically significant degree of comorbidity, primarily with substance use disorder. Depression in both groups was more likely to occur after the other disorder rather than to precede it. Comorbidity did not affect the duration or severity of depression. Comorbidity in the adolescents was associated with greater frequency of suicidal behavior and treatment seeking. The findings suggest that early-onset depression is associated with a greater degree of comorbidity and may represent a more serious form of the disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal look at the relation between depression and anxiety in children and adolescents.

Elementary school students (n?=?330) and their parents (n?=?228) participated in a 3-year longitudinal study of the temporal relation between anxiety and depressive symptoms in children. Every 6 months, children and parents completed depression and anxiety questionnaires for a total of 6 waves. Structural equation modeling revealed that individual differences on all measures were remarkably stable over time. Nevertheless, high levels of anxiety symptoms at 1 point in time predicted high levels of depressive symptoms at subsequent points in time even after controlling for prior levels of depression symptoms. These findings were consistent across self- and parent reports. Results support the temporal hypothesis that anxiety leads to depression in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of depression in children and adolescents.

In recent decades, research on child and adolescent depression has proliferated. Currently, attention in the field is directed toward examining the epidemiology, causes, course, sequelae, and treatment response of children at risk for developing or presently experiencing depressive disorders. In this article, a developmental psychopathology approach is used to elucidate the development of depressive disorders, the diverse pathways that evolve, and the processes that contribute to varied outcomes. The developmental psychopathology perspective underscores the importance of moving beyond the identification of isolated aberrations in psychological and biological components of depressive presentations to the understanding of how those components have evolved and how they are integrated within and transact across biological, psychological, and social systems. Implications for prevention and intervention are addressed as is the importance of increasing the public awareness of depressive disorders and reducing the social stigma that interfere with the attainment of treatment for depressed persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive attributes of depression in children and adolescents.

This study explores whether cognitive attributes differentiate depressed children from those with other psychiatric disorders. The subjects were 108 children from 7 to 17 years of age. Forty-seven children were diagnosed as currently depressed, 30 as having had an episode of major depression within the last year (depressed-resolved), and 31 with diagnoses other than depression (nondepressed). The subjects completed the Piers-Harris Children's Self-Concept Scale, the Children's Hopelessness Scale, the Nowicki-Strickland Children's Locus of Control Scale, the Children's Attributional Styles Questionnaire, and the Children's Depression Inventory. The depressed children endorsed significantly lower self-esteem, more hopelessness, a more externalized locus of control, and a more depressive attributional style than the depressed-resolved or the nondepressed children. Thus, a depressive cognitive style can be documented in clinically depressed young people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive bias and depression in psychiatrically disturbed children and adolescents.

Developed a cognitive bias questionnaire for children (CBQC) to examine the relation between cognitive distortion and depression in 39 psychiatrically disturbed 8–16 yr olds. Results indicate that the Depressed–Distorted scale from the CBQC was significantly correlated with Ss' psychiatric and self-reported ratings of depression and could significantly discriminate affective from nonaffective disorders. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Control-related beliefs and depression among clinic-referred children and adolescents.

Does childhood depression involve a perceived lack of control? The answer may depend on which dimension of control one examines. Here, building on recent theory, we distinguished between two dimensions: beliefs about the contingency of outcomes and beliefs about one"s own competence to perform outcome-relevant behavior. Three separate groups of clinic-referred children (aged 8–17) were sampled, one before therapy and two afterward. In all three groups, low levels of perceived competence were significantly correlated with children"s Childhood Depression Inventory (CDI) scores. Multiple regression analyses with several predictors revealed that, in each sample, competence beliefs accounted for substantial unique variance in CDI scores. In contrast, contingency beliefs were not correlated with CDI scores in any of the samples. Finally, CDI scores were consistently correlated with attributions of success and failure to "unknown"" causes. Overall, the results link childhood depression to perceived incompetence and to "contingency uncertainty,"" but not to perceived noncontingency. This suggests, in turn, that children may be more susceptible to "personal helplessness"" forms of depression than to forms identified with "universal helplessness."" (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of unipolar depression: I. Major depression with dysthymia.

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n?=?1,710) and adults (n?=?2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had become depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mixed anxiety and depression.

Reviews evidence from community, primary care, and psychiatric samples to determine whether there is a group of patients who have mixed symptoms of anxiety and depression that are below diagnostic thresholds for either group of disorders. A review of the data strongly suggests that such a group of patients exists and that, despite lacking sufficient symptoms to meet diagnostic thresholds from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III—R; American Psychiatric Association, 1987), they often have significant impairment in social and vocational functioning. Because many of these patients also suffer from medically unexplained somatic symptoms, they may be more likely to frequently use nonpsychiatric medical care. Longitudinal studies suggest that persons with mixed anxiety-depression symptoms may represent a population who are at increased risk for more severe mood and anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electroencephalographic asymmetries in adolescents with major depression: Influence of comorbidity with anxiety disorders.

This study examined whether adolescents with major depressive disorder (MDD) display the abnormal electroencephalographic (EEG) alpha asymmetries found in depressed adults. Resting EEG was recorded in 25 right-handed female outpatients (19 with MDD, 11 of whom also had a current anxiety disorder; 6 with anxiety disorders only) and 10 non-ill controls. In contrast to the non-ill controls, adolescents having MDD but no anxiety disorder showed alpha asymmetry indicative of less activation over right than over left posterior sites. Within the MDD patient group, comorbid anxiety disorders reduced the posterior alpha asymmetry, supporting the potential importance of evaluating anxiety in studies of regional brain activation in adolescent MDD. These preliminary findings are similar to those from adult studies that suggest that MDD is associated with right parietotemporal hypoactivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in anxiety disorders and anxiety symptoms in adolescents.

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacologic treatment for children and adolescents with anxiety disorders

Pediatric anxiety disorders are common illnesses that, if left untreated, may induce academic, family, and interpersonal problems. Cognitive-behavioral techniques and other psychotherapeutic interventions may be adequate for the treatment of most anxiety disorders. For patients with severe symptoms or for whom psychotherapeutic approaches are not adequate, medications are indicated. Among the available medications, the SSRIs are currently the first choice; however, other medications, such as the benzodiazepines and the TCAs, may be used alone or sometimes in combination with the SSRIs. Caution with respect to medication interactions and side effects is indicated. In particular, long-term side effects in these medications have not been well studied.     

Relation between symptoms of anxiety and depression in children: A multitrait-multimethod-multigroup assessment.

Teacher, parent, peer, and self-ratings of depression and anxiety symptoms were obtained from 280 3rd-grade and 211 6th-grade children. Confirmatory factor analysis of these multitrait-multimethod data for 3rd graders revealed low but statistically significant levels of convergent validity, high levels of method variance, and an extremely high correlation between the depression and anxiety factors, even after controlling for shared method variance. Similar analyses of 6th graders revealed slightly higher levels of convergent validity and a somewhat smaller correlation between the depression and anxiety factors. The data support a unified construct model for younger children and are consistent with either a dual factor or a tripartite model of depression and anxiety in older children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of self-reported depression: Clinic-referred children versus adolescents.

The literature on childhood depression has often treated children and adolescents as a homogeneous group. However, research on cognitive and affective development suggests that the nature of depression may be different for these two age groups. We explored this possibility, separately factor analyzing Children's Depression Inventory responses for 110 clinic-referred children (aged 8–11 years) and 139 adolescents (aged 12–26 years). Although both groups produced three-factor solutions, a number of developmental differences were noted. All of the adolescent factors were correlated with parent prceptions of externalizing behavior, but none of the child factors were. Furthermore, gender differences on the factors were found for the adolescents only. An inspection of communality estimates indicated that whereas all of the CDI items were relatively involved in depression for the adolescents, only 20 of 26 items were involved for the children. Theoretical interpretation of the results was deferred pending replication of the factor structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents

Evaluated the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) generalized anxiety disorder (GAD) criteria in children and adolescents. Clinic-referred children meeting criteria for DSM-IV GAD, those meeting criteria for another DSM-IV anxiety disorder, and normal children participated in a structured interview and completed self-report questionnaires. Groups were compared in terms of interview and self-report measures to examine convergent and discriminant validity. In addition, developmental differences, cross-informant symptom and syndrome agreement, and validity of parent and child report were determined. Finally, the symptoms comprising the GAD associated symptom criterion (Criterion C) were examined in terms of rate of endorsement and predictive power. Results showed that parameters of worry differentiated children with GAD from those with other anxiety disorders and controls. Developmental differences in the sample did not appear to necessitate a separate criteria set for the classification of generalized anxiety in children of this age. Symptoms from GAD Criterion C evidenced moderately high rates of endorsement and acceptable predictive power. Overall, the DSM-IV GAD criteria for children and adolescents are supported, but further evaluation is necessary before firm conclusions can be drawn.     

Neuropsychological differentiation of depression and anxiety.

The high comorbidity of depression and anxiety is well established empirically but not well understood conceptually, in terms of either psychological or biological mechanisms. A neuropsychological model of regional brain activity in emotion provides contrasting hypotheses for depression and anxiety, with depression associated with a relative decrease and anxiety with a relative increase in right-posterior activity. These hypotheses received support in a comparison of individuals diagnosed with depression and community controls, and also in a separate study of nonpatients administered a measure of perceptual asymmetry. Hierarchical regressions revealed that depression and anxiety were uniquely and jointly associated with perceptual asymmetry. In light of consistent empirical support for the model, implications for conceptualizations of the comorbidity of depression and anxiety are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of personality disorders and depression: Implications for treatment.

Reviews naturalistic and controlled studies of the impact of comorbidity of personality disorders and depression on response to various forms of treatment. The findings support the common belief that personality disorders are associated with a poorer response to treatment for depression. In contrast, the limited data available suggest that the presence of depression may be a positive prognostic indicator for patients with borderline and antisocial personality disorder. There are insufficient data to draw conclusions regarding the influence of specific types of personality disorders on outcome with specific forms of treatment for depression. More specific assessment of personality disorders, particularly of possible underlying dimensions, is likely to be a more fruitful approach than the currently used categorical approach in identifying effective treatments for patients with personality disorders and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)