Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: protocol for randomised controlled trial.

INTRODUCTION: There are unmet mental health needs of depressed adolescents and young adults (AYAs) across the USA. Behavioural technology adequately integrated into clinical care delivery has potential to improve care access and efficiency. This multisite randomised controlled trial evaluates how a coach-enhanced digital cognitive behavioural intervention (dCBI) enhances usual care for depressed AYAs in paediatric practices with minority enriched samples. METHODS AND ANALYSIS: Participants (n=750) ages 16-22 who meet threshold criteria for depressive severity (Patient Health Questionnaire-9; PHQ-9 score 10-24) will be recruited through paediatric practices across three academic institutions (Boston, Pittsburgh and San Diego). Participants will be randomised to 12 weeks of dCBI+treatment as usual (TAU) (n=450) or TAU alone (n=300) in outpatient paediatric practices. Assessments will be completed at baseline, 6 weeks and 12 weeks with the primary outcome being improvement in clinician-rated and self-reported depressive severity (Children's Depression Rating Scale-Revised and PHQ-9) and secondary outcomes being self-reported suicidal ideation (item 9 on PHQ-9), anxiety severity (Generalised Anxiety Disorder), general quality of life (Satisfaction with Life Scale) and general functioning (Children's Global Assessment Scale). The study design is an intent-to-treat mixed effects regression with group, and covariates nested within the sites. ETHICS AND DISSEMINATION: All participants or their parent/guardian (under 18 years or unemancipated) will give informed consent to a study team member. All data are expected to be collected over 18 months. The Institutional Review Board (IRB) is a board at each institution in the United States that reviews and monitors research involving human subjects. IRB approval from the University of Pittsburgh was obtained on 30 November 2021 (STUDY21080150), from the University of California San Diego's Human Research Protection Program IRB on 14 July 2022 (802047), and from the Boston Children's Hospital IRB on 25 October 2022 (P00040987). Full study results are planned to be published within 2 years of initial study recruitment (October 2024). Dissemination of findings will occur in peer-reviewed journals, professional conferences and through reports to participating entities and stakeholders. TRIAL REGISTRATION NUMBER: NCT05159713; ClinicalTrials.gov.

Feasibility and Caregiver Receptiveness to Anxiety Screening in Pediatric Cardiology Clinic: A Pilot Study.

Children with chronic medical conditions, including heart disease, have increased susceptibility to behavioral health concerns. We sought to evaluate the feasibility and parental opinion of anxiety screening in pediatric cardiology clinic. The PROMIS Pediatric Anxiety v2.0 Short Form 8a (PA2-S8) questionnaire was administered to 48 patients presenting to pediatric cardiology clinic for follow-up care. Parents/caregivers were asked their opinion on anxiety screening in cardiology clinic. The survey was completed by 47 out of 48 participants (median age 13, range 9-17). Fourteen (30%) participants had scores suggestive of increased anxiety symptomatology. No trends were identified between PA2-S8 score and age at diagnosis (P = .13), age at survey administration (P = .28), number of lifetime procedures (P = .89), number of noncardiac specialists (P = .13), or underlying cardiac diagnoses (P = .55). Most families (76%) were in favor of the screening effort. This study suggests that anxiety screening in cardiology clinic is both feasible and well-received by families.

Young children with psychotic symptoms and risk for suicidal thoughts and behaviors: a research note.

OBJECTIVE: Suicidal thoughts and behaviors (STBs) are prevalent among youth with psychotic disorders (PD) relative to the general population. Recent research now suggests that STBs may present during the prodromal phase of the disease, or the clinical high risk (CHR) state. While this knowledge is important for the development of suicide prevention strategies in adolescent and adult populations, it remains unclear whether risk for suicide extends to children with or at risk for psychosis. The current study is an extension of previous work assessing STBs in youth across the psychosis continuum. We examine STBs in 37 CHR and PD children ages 7-13 years old, and further explore the prodromal symptom correlates of STB severity among CHR children. RESULTS: CHR and PD children endorsed STBs with a frequency and severity similar to what is observed in older CHR and PD populations. A number of children had never previously vocalized their suicidal plans or intent. Among CHR children, Social Anhedonia and Odd Behavior or Appearance were significantly correlated with STB severity. These findings underscore the importance of screening for STBs even in young children presenting with psychotic symptoms.

Prospective Relations between Overeating, Loss of Control Eating, Binge Eating, and Depressive Symptoms in a School-Based Sample of Adolescents.

A sample of 353 community adolescents (grades 9 to 12, 57.6 % female) participated in a 2-wave longitudinal study of eating behaviors (overeating, loss of control eating [LOC], and binge eating) and depression. The study addresses 4 hypotheses. (1) The prospective relations between eating behaviors and depressive symptoms will be reciprocal, with each predicting the other over time. (2) These relations will be stronger for girls than for boys. (3) These relations will be stronger for adolescents with high (not low) body mass index (BMI). (4) LOC will show incremental predictive utility in relation to depressive symptoms over and above overeating. Evidence supported reciprocal relations between binge eating and depressive symptoms and between overeating and depressive symptoms, but not between LOC and depressive symptoms. Sex and BMI did not substantially moderate these relations. Taken separately, overeating but not LOC predicted depressive symptoms. Taken together, neither predictor was significant controlling for the other. Results raise questions about the importance of LOC alone in predicting depressive symptoms in adolescence.

Longitudinal and Incremental Relation of Cybervictimization to Negative Self-Cognitions and Depressive Symptoms in Young Adolescents.

Adolescents are among the most frequent users of social media websites, raising concern about the dangers of cyber bullying or cybervictimization (CV). A 12-month longitudinal study examined the unique, prospective relation of CV to the development of negative self-cognitions and depressive symptoms in a community sample of 827 children and young adolescents (ages 8-13; 55.1 % female) from the southeastern United States. Over and above conventional types of peer victimization, CV significantly predicted changes in self-referential negative cognitions, victimization-related cognitive reactions, and depressive symptoms, even after controlling for baseline levels of the dependent variables. Results also showed that CV was significantly less stable than other forms of victimization and tended to increase slightly with time. The study highlights the unique effects of CV and has implications for research and practice.

Peer Victimization and Harsh Parenting Predict Cognitive Diatheses for Depression in Children and Adolescents.

The current study examined peer victimization and harsh parenting as longitudinal predictors of broadband and narrowband cognitions associated with the etiology of depression in children and adolescents. The sample consisted of 214 elementary and middle school students. At the start of the study, their average age was 12.2 years (SD = 1.0). The sex ratio was 112 girls to 102 boys. The sample was ethnically diverse (58.9% Caucasian, 34.1% African American, 10.7% Hispanic, 3.3% Asian, and 5.2% other). Children and their parents completed measures of peer victimization and harsh parenting. At two waves 1 year apart, children also completed questionnaire measures of negative and positive broadband cognitive style (e.g., personal failure, global self-worth) and narrowband self-perceptions (e.g., perceived social threat, social acceptance). Every Wave 2 cognitive variable was predicted by peer victimization or harsh parenting or both, even after controlling for a Wave 1 measure of the same cognitive variable. Peer victimization more consistently predicted narrowband social/interpersonal cognitions, whereas harsh parenting more consistently predicted broadband positive and negative cognitions. Furthermore, controlling for positive and negative self-cognitions eliminated a statistically significant effect of harsh parenting and peer victimization on depressive symptoms. Support emerged for the social learning of negative self-cognitions. Support also emerged for negative self-cognitions as a mediator of depressive symptoms. Implications for theory and practice are discussed.

Peer victimization (and harsh parenting) as developmental correlates of cognitive reactivity, a diathesis for depression.

Prior research has shown cognitive reactivity to be a diathesis for depression. Seeking evidence for the developmental origins of such diatheses, the current study examined peer victimization and harsh parenting as developmental correlates of cognitive reactivity in 571 children and adolescents (ages 8-13 years). Four major findings emerged. First, a new method for assessing cognitive reactivity in children and adolescents showed significant reliability and demonstrated construct validity vis-à-vis its relation to depression. Second, history of more severe peer victimization was significantly related to cognitive reactivity, with verbal victimization being more strongly tied to cognitive reactivity than other subtypes of peer victimization. Third, harsh parenting was also significantly related to cognitive reactivity. Fourth, both peer victimization and harsh parenting made unique statistical contributions to cognitive reactivity, after controlling for the effects of the other. Taken together, these findings provide preliminary support for a developmental model pertaining to origins of cognitive reactivity in children and adolescents.