Parameter Space and Potential for Biomarker Development in 25 Years of fMRI Drug Cue Reactivity: A Systematic Review.

Importance: In the last 25 years, functional magnetic resonance imaging drug cue reactivity (FDCR) studies have characterized some core aspects in the neurobiology of drug addiction. However, no FDCR-derived biomarkers have been approved for treatment development or clinical adoption. Traversing this translational gap requires a systematic assessment of the FDCR literature evidence, its heterogeneity, and an evaluation of possible clinical uses of FDCR-derived biomarkers. Objective: To summarize the state of the field of FDCR, assess their potential for biomarker development, and outline a clear process for biomarker qualification to guide future research and validation efforts. Evidence Review: The PubMed and Medline databases were searched for every original FDCR investigation published from database inception until December 2022. Collected data covered study design, participant characteristics, FDCR task design, and whether each study provided evidence that might potentially help develop susceptibility, diagnostic, response, prognostic, predictive, or severity biomarkers for 1 or more addictive disorders. Findings: There were 415 FDCR studies published between 1998 and 2022. Most focused on nicotine (122 [29.6%]), alcohol (120 [29.2%]), or cocaine (46 [11.1%]), and most used visual cues (354 [85.3%]). Together, these studies recruited 19 311 participants, including 13 812 individuals with past or current substance use disorders. Most studies could potentially support biomarker development, including diagnostic (143 [32.7%]), treatment response (141 [32.3%]), severity (84 [19.2%]), prognostic (30 [6.9%]), predictive (25 [5.7%]), monitoring (12 [2.7%]), and susceptibility (2 [0.5%]) biomarkers. A total of 155 interventional studies used FDCR, mostly to investigate pharmacological (67 [43.2%]) or cognitive/behavioral (51 [32.9%]) interventions; 141 studies used FDCR as a response measure, of which 125 (88.7%) reported significant interventional FDCR alterations; and 25 studies used FDCR as an intervention outcome predictor, with 24 (96%) finding significant associations between FDCR markers and treatment outcomes. Conclusions and Relevance: Based on this systematic review and the proposed biomarker development framework, there is a pathway for the development and regulatory qualification of FDCR-based biomarkers of addiction and recovery. Further validation could support the use of FDCR-derived measures, potentially accelerating treatment development and improving diagnostic, prognostic, and predictive clinical judgments.

Alcohol Cue Processing in Co-Occurring Bipolar Disorder and Alcohol Use Disorder.

Importance: Reward circuitry dysfunction is a candidate mechanism of co-occurring bipolar disorder and alcohol use disorder (BD + AUD) that remains understudied. This functional magnetic resonance imaging (fMRI) research represents the first evaluation of alcohol cue reward processing in BD + AUD. Objective: To determine how alcohol cue processing in individuals with BD + AUD may be distinct from that of individuals with AUD or BD alone. Design, Setting, and Participants: This cross-sectional case-control study (April 2013-June 2018) followed a 2 × 2 factorial design and included individuals with BD + AUD, AUD alone, BD alone, and healthy controls. A well-validated visual alcohol cue reactivity fMRI paradigm was administered to eligible participants following their demonstration of 1 week or more of abstinence from alcohol and drugs assessed via serial biomarker testing. Study procedures were completed at the Medical University of South Carolina. Analysis took place between June and August 2022. Main Outcomes and Measures: Past-week mood symptoms were rated by clinicians using the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. The Alcohol Dependence Scale, Obsessive-Compulsive Drinking Scale, and Barratt Impulsiveness Scale were included questionnaires. Functional MRI whole-brain data were analyzed along with percent signal change within a priori regions of interest located in the ventral striatum, dorsal striatum, and ventromedial prefrontal cortex. Exploratory analyses of associations between cue reactivity and select behavioral correlates (alcohol craving, impulsivity, maximum number of alcohol drinks on a single occasion, and days since last alcohol drink) were also performed. Results: Of 112 participants, 28 (25.0%) had BD + AUD, 26 (23.2%) had AUD alone, 31 (27.7%) had BD alone, and 27 (24.1%) were healthy controls. The mean (SD) age was 38.7 (11.6) years, 50 (45.5%) were female, 33 (30%) were smokers, and 37 (34.9%) reported recent alcohol consumption. Whole-brain analyses revealed a BD × AUD interaction (F = 10.64; P = .001; η2 = 0.09) within a cluster spanning portions of the right inferior frontal gyrus and insula. Region of interest analyses revealed a main association of BD (F = 8.02; P = .006; η2 = 0.07) within the dorsal striatum. In each instance, individuals with BD + AUD exhibited reduced activation compared with all other groups who did not significantly differ from one another. These hypoactivations were associated with increased impulsivity and obsessive-compulsive alcohol craving exclusively among individuals with BD + AUD. Conclusion and Relevance: The findings of this study suggest conceptualizing reward dysfunction in BD + AUD by the potential interaction between blunted reward responsivity and deficient inhibitory control may help guide treatment development strategies. To this end, reduced right inferior frontal gyrus and insula alcohol cue reactivity represents a novel candidate biomarker of BD + AUD that may respond to pharmacological interventions targeting impulsivity-related neural mechanisms for improved executive control.

Results from a randomized, double-blind, placebo-controlled, crossover, multimodal-MRI pilot study of gabapentin for co-occurring bipolar and cannabis use disorders.

Disrupted brain gamma-aminobutyric acid (GABA)/glutamate homeostasis is a promising target for pharmacological intervention in co-occurring bipolar disorder (BD) and cannabis use disorder (CUD). Gabapentin is a safe and well-tolerated medication, FDA-approved to treat other neurological diseases, that restores GABA/glutamate homeostasis, with treatment studies supporting efficacy in treating CUD, as well as anxiety and sleep disorders that are common to both BD and CUD. The present manuscript represents the primary report of a randomized, double-blind, placebo-controlled, crossover (1-week/condition), multimodal-MRI (proton-MR spectroscopy, functional MRI) pilot study of gabapentin (1200 mg/day) in BD + CUD (n = 22). Primary analyses revealed that (1) gabapentin was well tolerated and adherence and retention were high, (2) gabapentin increased dorsal anterior cingulate cortex (dACC) and right basal ganglia (rBG) glutamate levels and (3) gabapentin increased activation to visual cannabis cues in the posterior midcingulate cortex (pMCC, a region involved in response inhibition to rewarding stimuli). Exploratory evaluation of clinical outcomes further found that in participants taking gabapentin versus placebo, (1) elevations of dACC GABA levels were associated with lower manic/mixed and depressive symptoms and (2) elevations of rBG glutamate levels and pMCC activation to cannabis cues were associated with lower cannabis use. Though promising, the findings from this study should be interpreted with caution due to observed randomization order effects on dACC glutamate levels and identification of statistical moderators that differed by randomization order (i.e. cigarette-smoking status on rBG glutamate levels and pMCC cue activation). Nonetheless, they provide the necessary foundation for a more robustly designed (urn-randomized, parallel-group) future study of adjuvant gabapentin for BD + CUD.

A Multimethod Examination of Sensitivity to Reward and Sensitivity to Punishment in Bipolar Disorder and Alcohol Dependence: Results from a 2 × 2 Factorial Design.

INTRODUCTION: Shared neurobehavioral characteristics of bipolar disorder (BD) and alcohol dependence (AD), including heightened sensitivity to reward (SR), may account for high rates of BD and AD co-occurrence (BD + AD). However, empirical research is lacking. The present multimethod investigation examined SR and sensitivity to punishment (SP) among these patient groups using a reliable and well-validated self-report questionnaire of SR and SP along with a laboratory task specifically designed to distinguish SR and SP activation. METHODS: One-hundred participants formed 4 groups: BD + AD (n = 40), BD (n = 18), AD (n = 25), and healthy controls (n = 17). Clinical interviews were administered, and participants completed the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSR-Q) and the Point Score Reaction Test behavioral task. Pearson correlations, hierarchical linear regression, and 2 × 2 factorial general linear modeling with Bonferroni-corrected pairwise comparisons were performed. RESULTS: BD and AD main effects were significant on self-reported SR and SP; however, BD × AD interactions were not. BD + AD individuals were significantly higher on self-reported SR than BD and AD individuals, yet all clinical groups were similar on SP. Behavioral response times did not distinguish groups nor did they associate with self-report data. DISCUSSION/CONCLUSION: BD and AD had additive, rather than interactive, effects on self-reported SR and SP. The methods employed, paired with their application to the present sample, may account for a lack of positive findings with behavioral data.

Performance of the interpersonal needs questionnaire in adolescent clinical samples: Confirmatory factor analyses and evaluation of measurement invariance.

OBJECTIVE: This study evaluated the factor structure, internal consistency reliability, construct and criterion validity, and measurement invariance of the Interpersonal Needs Questionnaire (INQ) among adolescents. METHOD: Participants (N = 539) included three distinct samples of youth drawn from two outpatient psychology clinics and an inpatient psychiatric unit. The combined sample was 63.3% female and had a mean age of 14.95 years (SD = 1.31 years). All participants completed the INQ as well as measures of depressive symptoms and suicide ideation. RESULTS: Confirmatory factor analyses indicated that the removal of three items from the thwarted belongingness subscale of the INQ was needed to achieve acceptable model fit. The resulting combined 12-item scale demonstrated good factor structure, internal consistency reliability, construct validity, and criterion validity. The modified 12-item INQ also demonstrated scalar invariance across subgroups defined by sex, race, and age. CONCLUSIONS: Findings support the use of this reduced 12-item version of the INQ among adolescents. Youth may have difficulty accurately responding to changes in item valence; thus, future research with youth should consider using a 12-item version of the INQ that avoids valence changes within subscales.

Dating Violence Victimization, Nonsuicidal Self-Injury, and the Moderating Effect of Borderline Personality Disorder Features in Adolescent Inpatients.

The aim of the study was to examine whether Borderline Personality Disorder (BPD) features moderate the relation between dating violence victimization (DVV) experiences and nonsuicidal self-injury (NSSI) in adolescent inpatients. A total of 184 adolescent inpatients completed measures on DVV, BPD features, and NSSI at admission to treatment. Bivariate analyses revealed significant relations between DVV, BPD features, and NSSI. Hierarchical multiple regression analyses demonstrated a moderating effect of BPD features such that in the low BPD features group, more severe DVV was associated with greater NSSI frequency; adolescents in the high BPD group endorsed elevated, though stable, levels of NSSI at all levels of DVV. BPD features differentially affect the relationship between DVV and NSSI. Low BPD adolescents exposed to high DVV appear to self-injure more frequently and at rates similar to high BPD adolescents when faced with more severe DVV, while DVV appears neither necessary nor sufficient to be the cause of NSSI in high BPD adolescents. Our results indicate that DVV may be a particularly important focal point for treating adolescents who self-injure and have been victimized by a dating partner. As such, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavior Therapy (DBT) may serve as valuable clinical interventions.

Experiential Avoidance Predicts Persistence of Major Depressive Disorder and Generalized Anxiety Disorder in Late Adolescence.

OBJECTIVE: Experiential avoidance (EA) is a transdiagnostic construct that may underlie the high comorbidity between major depressive disorder (MDD) and generalized anxiety disorder (GAD). This analysis used data from a longitudinal study (conducted September 2010-April 2016) to examine whether adolescent EA varies by MDD and GAD symptomatology trajectory and predicts said trajectories. Longitudinal associations between EA, anxiety, and depression symptoms were also examined. METHODS: Adolescents aged 15 to 20 years (N = 183) were followed for 2 years using a comprehensive assessment battery. Symptom trajectory modeling, using weekly symptom ratings, identified 4 MDD and 4 GAD trajectories that were collapsed to form combined MDD/GAD trajectory groups: Persistent (n = 81), High-Decreasing (n = 44), Normal-Increasing (n = 37), and Minimal (n = 21). Group-based trajectory modeling, analyses of covariance, structural equation modeling, and linear regression analyses were performed. DSM-IV-TR criteria were used for MDD and GAD diagnoses. RESULTS: The Persistent adolescents had higher EA than other groups (P values ≤ .001), with greater EA stability versus High-Decreasing adolescents (P = .008). EA predicted anxiety and depressive symptoms alike (P values ≤ .005), which in turn did not predict EA (P values ≥ .188). EA, at both time points, predicted combined MDD/GAD trajectories after adjustment for depressive and anxiety symptoms and other confounders (P values < .001). CONCLUSIONS: EA appears to be an important predictor of MDD and GAD symptomatology in older adolescents, potentially serving as a treatment target. Findings suggest a possible trait-like nature for EA, perhaps increasing risk for the emergence and persistence of MDD and/or GAD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02147184​.

Delay discounting and reward sensitivity in a 2 × 2 study of bipolar disorder and alcohol dependence.

BACKGROUND AND AIMS: Separate studies have shown increased delay discounting in people with bipolar disorder (BD) and people with alcohol dependence (AD) relative to people without mental health problems. Delay discounting was compared in people with no mental health problems, AD, BD and AD plus BD. Associations of delay discounting with self-reported impulsivity and reward sensitivity were also assessed. DESIGN: The study was a two-by-two factorial comparative observational design. SETTING: Data were collected at baseline diagnostic visits as part of a neuroimaging study at a medical university in South Carolina, USA. PARTICIPANTS: Twenty-two BD + AD, 33 BD, 28 AD and 27 people without mental health problems participated. MEASUREMENTS: Diagnostic and clinician-rated symptom measures, self-report questionnaires and a computerized delay discounting task were administered. Two-by-two general linear univariate models were tested to examine between-group differences on discounting rates, and bivariate correlations and hierarchical regression analyses were performed to examine associations between discounting rates and self-reported reward sensitivity and impulsivity. FINDINGS: There was a significant main effect of AD (P = 0.006, η2  = 0.068). The main effect of BD and the BD × AD interaction terms were non-significant (P ≥ 0.293, η2  ≤ 0.010). Reward sensitivity and impulsivity were not significantly associated with discounting rates after adjustment for the other (P ≥ 0.089). CONCLUSIONS: People with alcohol dependence appear to have higher delay discounting, while previously found associations between bipolar disorder and delay discounting may be secondary to alcohol use disorder.

Measurement invariance of depression symptom ratings across African American, Hispanic/Latino, and Caucasian adolescent psychiatric inpatients.

The Beck Depression Inventory-II (BDI-II) is widely used to assess adolescent depressive symptom severity. Psychometric investigations, including factor-analytic studies, with adolescents support the reliability and validity of the BDI-II. However, a major limitation of this research is that samples have been predominantly Caucasian/White. This is critical because depressive illness is highly prevalent across race and ethnicity, and the extent to which reliability and findings generalize to non-Caucasian populations is in question. The present study recruited African American/Black (n = 96), Hispanic/Latino(a) (n = 151), and Caucasian/White (n = 97) adolescent psychiatric inpatients (Mage = 14.73) to test the measurement invariance of the BDI-II, using Osman and colleagues' two-factor solution while also assessing within-group reliability and concurrent validity by examining associations with other symptom measures. Across groups, the two-factor solution, factor loadings, and indicator thresholds were invariant. Within-group reliability estimates were adequate, and the concurrent validity was supported. This suggests BDI-II symptom comparisons between African American/Black, Hispanic/Latino(a), and Caucasian/White adolescent inpatients are valid. Critical extensions of this work may include the examination of potential invariance across depressive symptom clusters via network analysis and invariance testing of depression symptom ratings over time in ethnoracially diverse children and adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An evaluation of the impact of co-occurring anxiety and substance use disorder on bipolar disorder illness outcomes in STEP-BD.

BACKGROUND: Anxiety disorder (AD) and substance use disorder (SUD) highly co-occur with bipolar disorder (BD). AD and/or SUD co-occurrence is associated with poorer clinical outcomes in BD. However, respective associations between AD and/or SUD diagnoses and BD outcomes require clarification. Baseline data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were therefore utilized to investigate independent and simultaneous contributions of ADs and SUDs on clinical variables in BD. METHODS: Two latent factors, "pathological anxiety" and "substance use problems," were derived from presence/absence of lifetime AD and SUD diagnoses. Latent dimensions' associations with clinical variables, obtained from the Affective Disorders Evaluation, Mini-International Neuropsychiatric Interview and Range of Impaired Functioning, were estimated via structural equation modeling (SEM). RESULTS: Modeled independently, pathological anxiety and substance use problems were significantly associated with several variables. Yet when modeled simultaneously, pathological anxiety's associations with functional impairment, past-year rapid cycling, and past-year %time spent anxious and depressed remained while most variables' associations with substance use problems became non-significant. The only significant latent-factor interaction evidenced was for age of BD onset. LIMITATIONS: Analyses were limited to lifetime diagnoses and causality may not be inferred given cross-sectional data. CONCLUSIONS: ADs and SUDs impact on BD was mostly additive rather than synergistic. Findings highlight the potentially understated importance of treating inter-episodic anxiety in BD as it may exacerbate mood symptoms, increasing functional impairment and risk for subsequent mood episodes.

Interpersonal Trust and Suicide Ideation Among Adolescent Psychiatric Inpatients: An Indirect Effect via Perceived Burdensomeness.

The identification of theoretically and empirically supported correlates of suicide ideation is important to improve treatment approaches to suicide. This study sought to examine the association between interpersonal trust (theoretically conceptualized as a distal risk marker) and suicide ideation in adolescence. Specifically, it was hypothesized that interpersonal trust would be negatively associated with suicide ideation via perceived burdensomeness and thwarted belongingness (conceptualized as more proximal risk markers). Data were drawn from a cross-sectional sample of 387 adolescent inpatients between the ages of 12 and 17 years (M = 14.72, SD = 1.49). The sample was 63.6% female, 37.5% Hispanic, 26.9% African American/Black, and 25.8% Caucasian. Adolescents completed a series of self-report measures to assess thwarted belongingness, perceived burdensomeness, interpersonal trust, depressive symptoms, and suicide ideation. A structural equation model was fit to the data, and results demonstrated a significant indirect path from interpersonal trust to suicide ideation via perceived burdensomeness, but not thwarted belongingness. Results suggest that interpersonal trust may be a distal risk marker for suicide ideation and that interventions to increase interpersonal trust may help prevent the development of thwarted belongingness, perceived burdensomeness, and suicide ideation.

Trust and general risk-taking in externalizing adolescent inpatients versus non-externalizing psychiatric controls.

BACKGROUND: Interpersonal trust is an important target for the conceptualization, identification, and treatment of psychiatric disorders marked by interpersonal difficulties. A core feature of adolescent externalising disorders is interpersonal impairment. However, research investigating trust is scarce. A relatively novel approach for studying trust in psychopathology is through examination of social decision making using behavioural economic games. OBJECTIVE: To employ a modified trust game in order to determine whether externalising adolescents exhibit perturbed decision making in social and/or nonsocial contexts. METHODS: Externalising inpatient adolescents (n = 141) and non-externalising psychiatric controls (n = 122) completed self-report measures of psychopathology and invested in an iterative trust game played under two conditions: social (trust) and nonsocial (lottery condition), each consisting of five consecutive trials. RESULTS: Externalising adolescents showed a limited increase in trust investments, compared to a significant increase in lottery investments, across early game trials relative to psychiatric controls. This significant three-way interaction between experimental group, game condition, and trials became most evident at the second trial of games. Between-group differences on trust investments were non-significant. However, externalising adolescents invested significantly less in the trust relative to lottery condition, an effect unobserved in psychiatric controls. CONCLUSIONS: This study tentatively suggests that adolescent externalising disorders may be associated with an insensitivity to normative social exchange which may arise, in part, from a lack of anticipated co-player reciprocity. It is not the level of trust that may distinguish externalising adolescents but perhaps the form of which the trust exchange takes shape. Conclusions are tempered by the fact that the employed trust game did not include feedback in the form of co-player repayments.

Depressive adolescent girls exhibit atypical social decision-making in an iterative trust game.

INTRODUCTION: Interpersonal trust behavior is an important target for the identification and treatment of psychiatric disorders with interpersonal dysfunction. Adolescent depression is a highly interpersonal disorder marked by impaired social interactions. However, trust has received little empirical attention. The examination of reward-related decision-making using behavioral economic methods is a relatively novel approach for studying trust in adolescent depression. The present study employed a modified trust game to examine whether depressive adolescents exhibited perturbed reward-related decision-making in social and/or nonsocial contexts. METHODS: One-hundred and thirty adolescent girls (65 depressive, 65 healthy comparisons) played a modified trust game under two conditions, interpersonal risk-taking (trust) and general risk-taking (lottery), and completed self-report psychopathology measures. RESULTS: Three-way repeated measures ANCOVA analyses revealed a significant group x game interaction such that while the depressive group invested more across trials in the trust game they invested similarly to healthy comparisons in the lottery condition. DISCUSSION: Findings highlight the interpersonal nature of adolescent depression. Future research may help determine whether increased trust behavior is characteristic of depression in adolescent girls. Behavioral economic games, like the trust game, may serve as valuable therapeutic tools for improving social interaction style among depressive adolescents.

Social cognition mediates the relation between attachment schemas and posttraumatic stress disorder.

OBJECTIVE: A social-cognitive perspective on posttraumatic stress disorder (PTSD) has been proposed and posits that impaired social cognition, rooted in attachment insecurity, plays a role in the development of PTSD. Support for the role of impaired social cognition in PTSD has been found in adults, but the social-cognitive perspective on PTSD has not been examined in adolescents. This study sought to explore differences in social cognition and PTSD on the basis of attachment security, and it examined social cognition as a mediator in the relation between attachment security and PTSD and with regard to PTSD symptom change during inpatient treatment. METHOD: We recruited 142 adolescents from an inpatient psychiatric hospital, where adolescents and their parents completed assessments at admission and discharge. RESULTS: Adolescents with a secure attachment demonstrated better social-cognitive skills than did those with an insecure attachment. Social cognition mediated the relation between adolescents' maternal attachment representations and PTSD at admission across 3 self- and parent-report measures. Social cognition also mediated the relation between adolescents' maternal attachment representations at admission and PTSD treatment outcome. CONCLUSION: This study provides the 1st support for the application of Sharp, Fonagy, and Allen's (2012) social-cognitive perspective of PTSD to adolescents by showing a link between clinically significant symptoms of PTSD and attachment security through social-cognitive impairment. Findings indicate that improvement in PTSD during medium-stay inpatient treatment is partially driven by baseline attachment security and social-cognitive abilities, highlighting the potential of social-cognitive skills as important targets of clinical intervention among adolescents with PTSD. (PsycINFO Database Record

The role of bullying in depressive symptoms from adolescence to emerging adulthood: A growth mixture model.

BACKGROUND: The present study sought to identify trajectories of depressive symptoms in adolescence and emerging adulthood using a school-based sample of adolescents assessed over a five-year period. The study also examined whether bully and cyberbully victimization and perpetration significantly predicted depressive symptom trajectories. METHOD: Data from a sample of 1042 high school students were examined. The sample had a mean age of 15.09 years (SD=.79), was 56.0% female, and was racially diverse: 31.4% Hispanic, 29.4% White, and 27.9% African American. Data were examined using growth mixture modeling. RESULTS: Four depressive symptoms trajectories were identified, including those with a mild trajectory of depressive symptoms, an increasing trajectory of depressive symptoms, an elevated trajectory of depressive symptoms, and a decreasing trajectory of depressive symptoms. Results indicated that bully victimization and cyberbully victimization differentially predicted depressive symptoms trajectories across adolescence, though bully and cyberbully perpetration did not. LIMITATIONS: Limitations include reliance on self-reports of bully perpetration and a limited consideration of external factors that may impact the course of depression. CONCLUSIONS: These findings may inform school personnel in identifying students' likely trajectory of depressive symptoms and determining where depression prevention and treatment services may be needed.

The Moderating Role of Maternal Depression in the Relation Between Adolescent Behavioral Inhibition and Maternal Critical Expressed Emotion.

Behavioral inhibition is associated with a range of negative affective states and behaviors in adolescents which may elicit critical expressed emotion (EE-Crit) among mothers. Whether the relation between adolescent behavioral inhibition and maternal EE-Crit may depend on the presence of maternal depression is unknown. Therefore, a total of N = 81 biological mother/adolescent daughter dyads were recruited: mothers with a history of major depressive disorder (n = 45) and never-depressed mothers (non-depressed: n = 36). Structured clinical interviews were administered, daughters reported their behavioral inhibition and mothers reported daughter-directed maternal EE-Crit. Maternal depression was a moderator such that higher daughter behavioral inhibition was associated with greater EE-Crit among depressed mothers, specifically. There were no group differences for daughter behavioral inhibition or maternal EE-Crit. These findings highlight the significant role that maternal depression may play in relation to adolescent behavioral inhibition, EE-Crit, and risk for the development of adolescent psychopathology.

Experiential avoidance in the vulnerability to depression among adolescent females.

BACKGROUND: Although various mechanisms in the maternal transmission of Major Depressive Disorder (MDD) have been investigated, it is unknown whether experiential avoidance (EA) is a vulnerability factor in the development of depression or a consequence of the illness. The present study utilized a high-risk design to determine if EA indeed poses vulnerability to adolescent MDD. Secondly, we examined the means by which adolescent EA may come to pose vulnerability, namely that it explains the relation between maternal EA and adolescent depressive symptoms. METHODS: One-hundred and forty-six biological mother/adolescent daughter dyads comprised three diagnostic groups: mothers with a history of MDD and their depressed daughters (MDD; n=21), mothers with a history of MDD and their never-depressed daughters (high-risk, HR; n=69), and healthy controls (HCs; n=56). RESULTS: Groups differed on daughter EA such that the MDD group reported greater EA than the HR group, which in turn reported greater EA than HCs. Daughter EA mediated the relation between maternal EA and daughter depressive symptoms after controlling for maternal depressive symptoms. LIMITATIONS: Strengths aside, this study included a relatively small group of depressed mother-daughter dyads and relied on cross-sectional self-report data. CONCLUSIONS: EA appears to serve as a vulnerability factor for adolescent MDD, and the mechanistic role of daughter EA highlights the significance of intergenerational EA in the maternal transmission of depression. Therapeutic approaches may therefore consider reducing the transmission of EA from mothers to daughters.

Mental State Decoding in Adolescent Boys with Major Depressive Disorder versus Sex-Matched Healthy Controls.

BACKGROUND: Several adult depression studies have investigated mental state decoding, the basis for theory of mind, using the Reading the Mind in the Eyes Test. Findings have been mixed, but a comprehensive study found a greater severity of depression to be associated with poorer mental state decoding. Importantly, there has yet to be a similar study of adolescent depression. Converging evidence suggests that atypical mental state decoding may have particularly profound effects for psychosocial functioning among depressed adolescent boys. SAMPLING AND METHODS: Adolescent boys with major depressive disorder (MDD, n = 33) and sex-matched healthy controls (HCs, n = 84) completed structured clinical interviews, self-report measures of psychopathology and the Child Eyes Test (CET). RESULTS: The MDD group performed significantly better than HCs on the CET overall (p = 0.002), underscored by greater accuracy for negatively valenced items (p = 0.003). Group differences on items depicting positive (p = 0.129) and neutral mental states (p = 0.081) were nonsignificant. CONCLUSIONS: Enhanced mental state decoding among depressed adolescent boys may play a role in the maintenance of and vulnerability to adolescent depression. Findings and implications are discussed. Limitations of this study include a reliance on self-report data for HC boys, as well as a lack of 'pure' depression among the boys with MDD.

Current maternal depression moderates the relation between critical expressed emotion in mothers and depressive symptoms in their adolescent daughters.

Prior studies have examined critical expressed emotion (EE-Crit) in mothers in the intergenerational transmission of depression. However, the potential moderating effect of maternal depression diagnostic status in relation to EE-Crit and youth depressive symptoms has yet to be determined. A total of N=121 biological mother/daughter dyads that differed in maternal depression diagnostic status were recruited for the present study: (1) currently depressed mothers (current depression, n=29); (2) formerly depressed mothers (past depression, n=39); and (3) mothers free from any psychiatric history (healthy controls, n=53). Mothers were administered structured clinical interviews and completed self-report measures of EE-Crit and psychopathology, and daughters self-reported depressive symptoms. Results indicated no significant group differences in EE-Crit; however, current maternal depression status moderated EE-Crit such that the magnitude of the relation between EE-Crit and adolescent depressive symptoms was significantly greater in daughters of currently depressed mothers. These findings highlight the importance of considering current maternal depression, rather than a history of maternal depression, in relation to EE-Crit and adolescent depressive symptoms, providing impetus for future investigations.

Neuroeconomics for the study of social cognition in adolescent depression.

Traditional social-cognitive approaches for investigating interpersonal problems in adolescent depression are limited. An important functional domain studied in adolescent depression is reward, but experimental paradigms have largely been non-social. In this paper, we propose the methods and concepts of neuroeconomics may address this gap. We begin by discussing a well-established social reward model for vulnerability to adolescent depression. We then show how neuroeconomics may extend this model by offering the tools to examine the mechanics of social exchanges, in behavioral and neural terms, that maintain (or pose vulnerability to) depression. In doing so, we propose a neureoconomic model of adolescent depression in which depression is defined as a perturbation of interpersonal motivational/reward exchange. This model serves to guide future research.