Intensive Longitudinal Assessment of Adolescents to Predict Suicidal Thoughts and Behaviors.

OBJECTIVE: Suicide is a leading cause of death among adolescents. However, there are no clinical tools to detect proximal risk for suicide. METHOD: Participants included 13- to 18-year-old adolescents (N = 103) reporting a current depressive, anxiety, and/or substance use disorder who owned a smartphone; 62% reported current suicidal ideation, with 25% indicating a past-year attempt. At baseline, participants were administered clinical interviews to assess lifetime disorders and suicidal thoughts and behaviors (STBs). Self-reports assessing symptoms and suicide risk factors also were obtained. In addition, the Effortless Assessment of Risk States (EARS) app was installed on adolescent smartphones to acquire daily mood and weekly suicidal ideation severity during the 6-month follow-up period. Adolescents completed STB and psychiatric service use interviews at the 1-, 3-, and 6-month follow-up assessments. RESULTS: K-means clustering based on aggregates of weekly suicidal ideation scores resulted in a 3-group solution reflecting high-risk (n = 26), medium-risk (n = 47), and low-risk (n = 30) groups. Of the high-risk group, 58% reported suicidal events (ie, suicide attempts, psychiatric hospitalizations, emergency department visits, ideation severity requiring an intervention) during the 6-month follow-up period. For participants in the high-risk and medium-risk groups (n = 73), mood disturbances in the preceding 7 days predicted clinically significant ideation, with a 1-SD decrease in mood doubling participants' likelihood of reporting clinically significant ideation on a given week. CONCLUSION: Intensive longitudinal assessment through use of personal smartphones offers a feasible method to assess variability in adolescents' emotional experiences and suicide risk. Translating these tools into clinical practice may help to reduce the needless loss of life among adolescents.

Self-referential Processing in Remitted Depression: An Event-Related Potential Study.

Background: Identifying mechanisms of major depressive disorder that continue into remission is critical, as these mechanisms may contribute to subsequent depressive episodes. Biobehavioral markers related to depressogenic self-referential processing biases have been identified in adults with depression. Thus, we investigated whether these risk factors persisted during remission as well as contributed to the occurrence of stress and depressive symptoms over time. Methods: At baseline, adults with remitted depression (n = 33) and healthy control subjects (n = 33) were administered diagnostic and stress interviews as well as self-report symptom measures. In addition, participants completed a self-referential encoding task while electroencephalography data were acquired. Stress interviews and self-report symptom measures were readministered at the 6-month follow-up assessment. Results: Drift diffusion modeling showed that compared with healthy individuals, adults with remitted depression exhibited a slower drift rate to negative stimuli, indicating a slower tendency to reject negative stimuli as self-relevant. At the 6-month follow-up assessment, a slower drift rate to negative stimuli predicted greater interpersonal stress severity among individuals with remitted depression but not healthy individuals while controlling for both baseline depression symptoms and interpersonal stress severity. Highlighting the specificity of this effect, results were nonsignificant when predicting noninterpersonal stress. For self-relevant positive words endorsed, adults with remitted depression exhibited smaller left- than right-hemisphere late positive potential amplitudes; healthy control subjects did not show hemispheric differences. Conclusions: Self-referential processing deficits persist into remission. In line with the stress generation framework, these biases predicted the occurrence of interpersonal stress, which may provide insight about a potential pathway for the re-emergence of depressive symptoms.

Neural sensitivity to peer feedback and depression symptoms in adolescents: a 2-year multiwave longitudinal study.

BACKGROUND: Depression risk increases during adolescent development, and individual differences in neural sensitivity to peer feedback (rejection vs. acceptance) may be a key diathesis in understanding stress-related depression risk. METHODS: At baseline, adolescents (12-14 years old; N = 124) completed clinical interviews and self-report symptom measures, and the Chatroom Task while MRI data were acquired. The majority of participants provided usable MRI data (N = 90; 76% female), which included adolescents with no maternal depression history (low risk n = 64) and those with a maternal depression history (high risk n = 26). Whole-brain regression models probed group differences in neural sensitivity following peer feedback, and whole-brain linear mixed-effects models examined neural sensitivity to peer feedback by peer stress interactions relating to depression symptoms at up to nine longitudinal assessments over 2 years. RESULTS: Whole-brain cluster-corrected results indicated brain activation moderating the strong positive association between peer interpersonal stress and depression over time. This included activation in the anterior insula, cingulate, amygdala, and striatum during anticipation and receipt of feedback (i.e., rejection vs. acceptance). Moderation effects were stronger when examining peer interpersonal (vs. non-interpersonal) stress and in relation to depression (vs. social anxiety) symptoms. CONCLUSIONS: Neural responses to peer feedback in key social and incentive processing brain regions may reflect core dispositional risk factors that interact with peer interpersonal stressors to predict adolescent depression symptom severity over time.

Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients.

Non-suicidal self-injury (NSSI) is a serious public health concern that typically onsets during early adolescence. Adolescents (N = 980, ages 12-19 years) admitted for acute, residential psychiatric treatment completed baseline clinical interviews assessing mental disorders and questionnaires measuring demographics, early life adversity, and symptom severity. Prevalence rates of NSSI for lifetime (thoughts: 78%; behaviors: 72%), past year (thoughts: 74%; behaviors: 65%), and past month (thoughts: 68%; behaviors: 51%) were high. Although effect sizes were modest, the presence of a lifetime depressive disorder, sexual abuse, and comorbidity (i.e., three or more current disorders) were significant correlates of experiencing NSSI thoughts and behaviors. Furthermore, lifetime depressive disorder, current anxiety disorder, and comorbidity were associated with a greater odds of persistent NSSI thoughts and/or behaviors. Longitudinal studies are needed to determine whether targeting these factors reduces the persistence of NSSI thoughts and behaviors.