A qualitative, multi-perspective study on causal beliefs about adolescent depression.

OBJECTIVES: The current study aimed to examine: (1.1) causal beliefs about adolescent depression in a sample of adolescents with a clinical depression and their mothers and fathers; (1.2) within-family overlap of causal beliefs; (2.1) mothers' and fathers' reflected causal beliefs about their child's perspective; (2.2) the accuracy of mothers' and fathers' reflected causal beliefs as related to their child's causal beliefs. DESIGN: Qualitative study using a within-family approach. METHODS: Adolescents with a current clinical depression (MDD/dysthymia; N = 34) and their parents (N = 34 mothers, N = 26 fathers) were independently interviewed about their causal beliefs about the adolescents' depression. Parents were additionally interviewed about their perception of their child's causal beliefs (i.e., reflected causal beliefs). RESULTS: The causal beliefs most frequently mentioned by adolescents, mothers and fathers are: characteristics of the child, social factors, school and various stressful experiences. Parent-child overlap was relatively low, specifically for the themes of bewilderment, cumulative effect and stressful life events, whereas overlap was relatively high for themes of social factors, school and stressful experiences outside of the family. Parents were relatively accurate in their reflected causal beliefs, but tended to underestimate their child's insights into possible causes of their depression. Accuracy of parents' reflected causal beliefs was particularly low for the theme cumulative effect and high for social factors. CONCLUSIONS: The various causal beliefs of adolescents and their parents could be used in therapeutic setting. Future research could examine whether (guided) conversations may promote alignment within families and treatment efficacy.

A closer look into the affect dynamics of adolescents with depression and the interactions with their parents: An ecological momentary assessment study.

Adolescents with depression tend to perceive behavior of parents as less positive than adolescents without depression, but conclusions are based on retrospective reports assessed once or over long time intervals, with the risk of memory biases affecting the recall. The current study used ecological momentary assessments to examine the link between adolescent affect and the amount of warmth and criticism expressed by both mothers and fathers in families with adolescents with depression versus adolescents without psychopathology in daily life. It also explored the possible bias by assessing parenting on the momentary, daily (EMA), and retrospective level. The sample consisted of 34 adolescents with depression and 58 parents and 80 healthy controls and 151 parents (adolescents: Mage = 15.8, SD = 1.41; 67.5% girls, parents: Mage = 49.3, SD = 5.73; 54.1% mothers). Participants completed retrospective questionnaires and four surveys a day for 14 consecutive days. Preregistered multilevel models showed that momentary parenting reports of adolescents with depression and healthy controls did not differ. The associations between perceived parenting of both mothers and fathers and adolescent affect did also not differ between the two groups. These results illustrate that adolescents generally benefit from supportive parenting, but substantial differences between individuals were found. In contrast to the momentary data, both adolescents with depression and their parents did report more negative parenting on retrospective questionnaires than healthy controls and their parents indicating that adolescents with depression may have a negativity bias in their retrospective recall. These findings are highly relevant for clinical practice and underscore the need for careful assessments on different time scales and including all family members.

Neural and affective responses to prolonged eye contact with parents in depressed and nondepressed adolescents.

Eye contact improves mood, facilitates connectedness, and is assumed to strengthen the parent-child bond. Adolescent depression is linked to difficulties in social interactions, the parent-child bond included. Our goal was to elucidate adolescents' affective and neural responses to prolonged eye contact with one's parent in nondepressed adolescents (HC) and how these responses are affected in depressed adolescents. While in the scanner, 59 nondepressed and 19 depressed adolescents were asked to make eye contact with their parent, an unfamiliar peer, an unfamiliar adult, and themselves by using videos of prolonged direct and averted gaze, as an approximation of eye contact. After each trial, adolescents reported on their mood and feelings of connectedness, and eye movements and BOLD-responses were assessed. In HCs, eye contact boosted mood and feelings of connectedness and increased activity in inferior frontal gyrus (IFG), temporal pole, and superior frontal gyrus. Unlike HCs, eye contact did not boost the mood of depressed adolescents. While HCs reported increased mood and feelings of connectedness to the sight of their parent versus others, depressed adolescents did not. Depressed adolescents exhibited blunted overall IFG activity. These findings show that adolescents are particularly sensitive to eye contact and respond strongly to the sight of their parents. This sensitivity seems to be blunted in depressed adolescents. For clinical purposes, it is important to gain a better understanding of how the responsivity to eye contact in general and with their parents in particular, can be restored in adolescents with depression.

Sticky criticism? Affective and neural responses to parental criticism and praise in adolescents with depression.

BACKGROUND: Parent-adolescent interactions, particularly parental criticism and praise, have previously been identified as factors relevant to self-concept development and, when negative, to adolescent depression. Yet, whether adolescents with depression show aberrant emotional and neural reactivity to parental criticism and praise is understudied. METHODS: Adolescents with depression (n = 20) and healthy controls (n = 59) received feedback supposedly provided by their mother or father in the form of negative ('untrustworthy'), neutral ('chaotic'), and positive ('respectful') personality evaluations while in an MRI-scanner. After each feedback word, adolescents reported their mood. Beforehand, adolescents had rated whether these personality evaluations matched their self-views. RESULTS: In both groups, mood decreased after criticism and increased after praise. Adolescents with depression reported blunted mood responses after praise, whereas there were no mood differences after criticism. Neuroimaging analyses revealed that adolescents with depression (v. healthy controls) exhibited increased activity in response to criticism in the subgenual anterior cingulate cortex, temporal pole, hippocampus, and parahippocampal gyrus. Praise consistent with adolescents' self-views improved mood independent of depression status, while criticism matching self-views resulted in smaller mood increases in adolescents with depression (v. healthy controls). Exploratory analyses indicated that adolescents with depression recalled criticism (v. praise) more. CONCLUSIONS: Adolescents with depression might be especially attentive to parental criticism, as indexed by increased sgACC and hippocampus activity, and memorize this criticism more. Together with lower positive impact of praise, these findings suggest that cognitive biases in adolescent depression may affect how parental feedback is processed, and may be fed into their self-views.

Looking into troubled waters: Childhood emotional maltreatment modulates neural responses to prolonged gazing into one's own, but not others', eyes.

One of the most prevalent nonverbal, social phenomena known to automatically elicit self- and other-referential processes is eye contact. By its negative effects on the perception of social safety and views about the self and others, childhood emotional maltreatment (CEM) may fundamentally affect these processes. To investigate whether the socioaffective consequences of CEM may become visible in response to (prolonged) eye gaze, 79 adult participants (mean [M]age = 49.87, standard deviation [SD]age = 4.62) viewed videos with direct and averted gaze of an unfamiliar other and themselves while we recorded self-reported mood, eye movements using eye-tracking, and markers of neural activity using fMRI. Participants who reported higher levels of CEM exhibited increased activity in ventromedial prefrontal cortex to one's own, but not to others', direct gaze. Furthermore, in contrast to those who reported fewer of such experiences, they did not report a better mood in response to a direct gaze of self and others, despite equivalent amounts of time spent looking into their own and other peoples' eyes. The fact that CEM is associated with enhanced neural activation in a brain area that is crucially involved in self-referential processing (i.e., vmPFC) in response to one's own direct gaze is in line with the chronic negative impact of CEM on a person's self-views. Interventions that directly focus on targeting maladaptive self-views elicited during eye gaze to self may be clinically useful.

Aberrant neural network activation during reliving of autobiographical memories in adolescent depression.

BACKGROUND: Adolescents with depression exhibit negative biases in autobiographical memory with detrimental consequences for their self-concept and well-being. Investigating how adolescents relive positive autobiographical memories and activate the underlying neural networks could reveal mechanisms that drive such biases. This study investigated neural networks when reliving positive and neutral memories, and how neural activity is modulated by valence and vividness in adolescents with and without depression. METHODS: Adolescents (N = 69; n = 17 with depression) retrieved positive and neutral autobiographical memories. On a separate day, they relived these memories during fMRI scanning, and reported on pleasantness and vividness after reliving each memory. We used a multivariate, data-driven approach - event-related independent component analysis (eICA) - to characterize neural networks supporting autobiographical recollection. RESULTS: Adolescents with depression reported their positive memories as significantly less pleasant compared to healthy controls, while subjective vividness was unaffected. Using eICA, we identified a broad autobiographical memory network, and subnetworks related to reliving positive vs neutral memories. These subnetworks comprised a 'self-referential processing network' including medial prefrontal cortex, posterior cingulate cortex/precuneus, and temporoparietal junction, anti-correlating with parts of the central executive network and salience network. Adolescents with depression exhibited aberrant activation in this self-referential network, but only when reliving relatively 'low' pleasant memories. CONCLUSIONS: Our findings provide first insights into how the quality of reliving autobiographical memories in adolescents with depression may relate to aberrant self-referential neural network activation, and underscore the potential of targeting memory reliving in therapeutic interventions to foster self-esteem and diminish depressive symptoms.

Neural and Affective Responses to Prolonged Eye Contact with One's Own Adolescent Child and Unfamiliar Others.

Eye contact is crucial for the formation and maintenance of social relationships, and plays a key role in facilitating a strong parent-child bond. However, the precise neural and affective mechanisms through which eye contact impacts on parent-child relationships remain elusive. We introduce a task to assess parents' neural and affective responses to prolonged direct and averted gaze coming from their own child, and an unfamiliar child and adult. While in the scanner, 79 parents (n = 44 mothers and n = 35 fathers) were presented with prolonged (16-38 s) videos of their own child, an unfamiliar child, an unfamiliar adult, and themselves (i.e., targets), facing the camera with a direct or an averted gaze. We measured BOLD-responses, tracked parents' eye movements during the videos, and asked them to report on their mood and feelings of connectedness with the targets after each video. Parents reported improved mood and increased feelings of connectedness after prolonged exposure to direct versus averted gaze and these effects were amplified for unfamiliar targets compared to their own child, due to high affect and connectedness ratings after videos of their own child. Neuroimaging results showed that the sight of one's own child was associated with increased activity in middle occipital gyrus, fusiform gyrus and inferior frontal gyrus relative to seeing an unfamiliar child or adult. While we found no robust evidence of specific neural correlates of eye contact (i.e., contrast direct > averted gaze), an exploratory parametric analysis showed that dorsomedial prefrontal cortex (dmPFC) activity increased linearly with duration of eye contact (collapsed across all "other" targets). Eye contact-related dmPFC activity correlated positively with increases in feelings of connectedness, suggesting that this region may drive feelings of connectedness during prolonged eye contact with others. These results underline the importance of prolonged eye contact for affiliative processes and provide first insights into its neural correlates. This may pave the way for new research in individuals or pairs in whom affiliative processes are disrupted.

Does the COVID-19 pandemic impact parents' and adolescents' well-being? An EMA-study on daily affect and parenting.

Due to the COVID- 19 outbreak in the Netherlands (March 2020) and the associated social distancing measures, families were enforced to stay at home as much as possible. Adolescents and their families may be particularly affected by this enforced proximity, as adolescents strive to become more independent. Yet, whether these measures impact emotional well-being in families with adolescents has not been examined. In this ecological momentary assessment study, we investigated if the COVID-19 pandemic affected positive and negative affect of parents and adolescents and parenting behaviors (warmth and criticism). Additionally, we examined possible explanations for the hypothesized changes in affect and parenting. To do so, we compared daily reports on affect and parenting that were gathered during two periods of 14 consecutive days, once before the COVID-19 pandemic (2018-2019) and once during the COVID-19 pandemic. Multilevel analyses showed that only parents' negative affect increased as compared to the period before the pandemic, whereas this was not the case for adolescents' negative affect, positive affect and parenting behaviors (from both the adolescent and parent perspective). In general, intolerance of uncertainty was linked to adolescents' and parents' negative affect and adolescents' positive affect. However, Intolerance of uncertainty, nor any pandemic related characteristics (i.e. living surface, income, relatives with COVID-19, hours of working at home, helping children with school and contact with COVID-19 patients at work) were linked to the increase of parents' negative affect during COVID-19. It can be concluded that on average, our sample (consisting of relatively healthy parents and adolescents) seems to deal fairly well with the circumstances. The substantial heterogeneity in the data however, also suggest that whether or not parents and adolescents experience (emotional) problems can vary from household to household. Implications for researchers, mental health care professionals and policy makers are discussed.

A meta-analytic review of parenting interventions in foster care and adoption.

Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.