Wider, faster, more: Re-envisioning the treatment and research of depression to address its public health burden in the United States

Depression and other internalizing disorder symptoms are leading causes of disability in theUnited States. Although there are effective interventions, the burden of disability attributableto internalizing disorder symptoms is not decreasing. I review clinical and epidemiological datato identify solutions to the public health burden of internalizing disorder symptoms. Contemporary research efforts have a focus on treatment development and the identification of biomarkers of response. However, these solutions are not scalable because internalizing disorders are much more common than usually appreciated and there are substantial disparities in access to mental health care. Improving the dissemination of individual interventions may also be of limited value given data suggesting that high rates of symptom remission can only be achieved with multiple (e.g., 4-10) treatment steps. The logic of stepped care approaches for internalizing disorders is well-supported by these data, but initial treatments likely should be low-intensity and “stepping up” should occur more quickly than usually done in most trials. Efforts that promise to make an impact in the public health burden of internalizing disorder symptoms need to consider their high prevalence and heterogeneity in the level of care as well as in the mechanisms that treatments may need to engage.

Depression and Social Anxiety Predict Internet Use Disorder Symptoms in Children and Adolescents at 12-Month Follow-Up: Results From a Longitudinal Study

Trajectories of internalizing disorders and behavioral addictions are still largely unknown. Research shows that both disorders are highly comorbid. Previous longitudinal studies have focused on associations between internalizing disorders and behavioral addictions using screening instruments. Our aim was to develop and examine a theory-based model of trajectories, according to which internalizing disorders foster symptoms of Internet use disorders, mediated by a reward deprivation and maladaptive emotion regulation. We applied clinically relevant measures for depression and social anxiety in a prospective longitudinal study with a 12-month follow-up investigation. On the basis of an at-risk population of 476 students (mean age = 14.99 years, SD = 1.99), we investigated the predictive influence of clinically relevant depression and social anxiety at baseline (t1) on Internet use disorder symptoms at 12-month follow-up (t2) using multiple linear regression analyses. Our results showed that both clinically relevant depression and social anxiety significantly predicted symptom severity of Internet use disorders one year later after controlling for baseline symptoms of Internet use disorders, gender and age. These results remained robust after including both depression and social anxiety simultaneously in the model, indicating an independent influence of both predictors on Internet use disorder symptoms. The present study enhances knowledge going beyond a mere association between internalizing disorders and Internet use disorders. To our knowledge, this is the first study investigating clinically relevant depression and social anxiety to predict future Internet use disorder symptoms at 12-month follow-up. In line with our model of trajectories, a significant temporal relationship between clinically relevant internalizing disorders and Internet use disorder symptoms at 12-month follow-up was confirmed. Further studies should investigate the mediating role of reward deprivation and maladaptive emotion regulation, as postulated in our model. One implication of these findings is that clinicians should pay particular attention to the increased risk of developing behavioral addictions for adolescents with depression and social anxiety.

Reward sensitivity and internalizing symptoms during the transition to puberty: An examination of 9-and 10-year-olds in the ABCD Study

Early pubertal timing has been linked to increased risk for internalizing disorders. Work in older adolescents and adults suggests that heightened reward sensitivity may buffer risk for internalizing symptoms, but few studies have investigated these associations during the early transition to puberty, a window of vulnerability to mental health risk. In this preregistered study, we investigated the associations among pubertal timing, internalizing symptoms, and reward sensitivity in 11,243 9-10 year-olds from the Adolescent Brain Cognitive Development (ABCD) Study®. Using split-half analysis, we tested hypothesized effects across two subsets of the sample (Sample 1 N=5,631 ; Sample 2 N=5,612). Across samples, early pubertal timing was associated with higher internalizing symptoms in females and males, with highest symptoms evident in mid-pubertal adolescents. Additionally, early pubertal timing was robustly associated with greater self-reported reward sensitivity in both females and males. We observed preliminary evidence of a moderating role of self-reported and neural reward sensitivity in the association between early pubertal timing and internalizing symptoms, but several of these effects differed by sex, and no moderation effects replicated across samples. Together, these findings provide novel insights into early indicators of risk for internalizing disorders during the transition to puberty.

Anxiety-impulsivity subtypes in adolescent internalizing disorder are characterized by distinguishable neurodevelopmental, neurocognitive and clinical trajectory signatures

Background Anxiety and impulsivity represent transdiagnostic pathology dimensions yet their interaction and contribution to emotional disorders in adolescence and to disease development remain controversial, and previous studies indicate heterogeneity within the broad category of internalizing disorders. Methods A combination of hierarchical and non-hierarchical clustering strategies was employed to determine impulsivity-related subtypes (based on the facets of negative urgency, lack of planning, lack of perseverance, sensation seeking and positive urgency in UPPS-P scales) in a large cohort of adolescents with internalizing disorders (n=2437) from Adolescent Brain Cognitive Development (ABCD) Study. Linear mixed-effect models were employed to determine cortical thickness alterations of the subtypes. Results Data-driven clustering identified two distinct subtypes of internalizing patients (subtype 1/subtype 2) with comparable levels of increased anxiety yet distinguishable levels of impulsivity, i.e., enhanced (subtype 1) or decreased (subtype 2) compared to healthy controls. Subtype 1 was further characterized by thicker prefrontal and temporal cortical regions involved in regulatory control and fear processing, while subtype 2 did not demonstrate significant thickness alterations. The differential neuroanatomical profiles remained stable over the two-year follow-up, while the two subtypes had different neurodevelopmental trajectories. Subtype 1 additionally reported more psychopathology and dysfunctionality including higher suicidal ideation, depressive symptoms and transition rates to externalizing disorders during follow-up as well as impaired neurocognitive and educational performance compared to subtype 2. Moreover, for subtype 1, anxiety at baseline (9-10 years) was significantly positively associated with impulsivity (lack of perseverance) at 2-year follow-up, while in subtype 2, baseline anxiety was significantly negatively associated with impulsivity (sensation seeking) at 2-year follow-up. Conclusions Our results demonstrate an impulsivity-dependent heterogeneity in adolescent internalizing disorders, with high-impulsivity patients being characterized by neurodevelopmental delay at the neural and cognitive levels. Individuals with elevated impulsivity are at a greater risk to develop behavioral dysregulation over the following two years and may thus require specific early interventions.

Developmental competencies, temperament, parenting practices and psychosocial adversities in internalizing disorders

<p>Research on the etiology of internalizing disorders has focused on biological and environmental factors, however, the role of developmental competencies has not been explored much. The aim of the current report is to understand the developmental competencies, temperament, parenting practices and psychosocial adversities in internalizing disorders. The relationship of each of these domains with functional impairment was also explored. The developmental competencies considered in this study include interpersonal competence, emotion regulation, executive functioning, adaptive behaviour and self-concept. The sample consisted of 30 children and adolescents with internalizing disorders belonging to the age group of six to 18, and one of their parents. Descriptive statistics and correlational analyses were used to analyse the data. The findings revealed that positive parenting shares an inverse relationship with functional impairment; other variables were not found to be related to impairment. On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. A model of a bidirectional relationship between individual and environmental factors together contributing to internalizing disorders has been proposed. The study will be continued on a larger scale on a clinical group and control group to test the significance of this model.</p>

Developmental competencies, temperament, parenting practices and psychosocial adversities in internalizing disorders

<p>Research on the etiology of internalizing disorders has focused on biological and environmental factors, however, the role of developmental competencies has not been explored much. The aim of the current report is to understand the developmental competencies, temperament, parenting practices and psychosocial adversities in internalizing disorders. The relationship of each of these domains with functional impairment was also explored. The developmental competencies considered in this study include interpersonal competence, emotion regulation, executive functioning, adaptive behaviour and self-concept. The sample consisted of 30 children and adolescents with internalizing disorders belonging to the age group of six to 18, and one of their parents. Descriptive statistics and correlational analyses were used to analyse the data. The findings revealed that positive parenting shares an inverse relationship with functional impairment; other variables were not found to be related to impairment. On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. A model of a bidirectional relationship between individual and environmental factors together contributing to internalizing disorders has been proposed. The study will be continued on a larger scale on a clinical group and control group to test the significance of this model.</p>